A ring trapped on a finger can sometimes be removed using string.
- Edema or anticipated edema when ring will not slide off finger
- Lacerations and fractures of the finger
- Finger deformity or arthrosis distal to the ring
- Laceration of underlying tissue
- Digital nerve injury
- Nonsterile gloves
- Mild antiseptic cleanser (eg, 2% chlorhexidine)
- String, umbilical tape, or thick silk sutures
- Local anesthetic (eg, 1% lidocaine)
- 25- or 27-gauge needle
- 10-mL syringe
- Penrose drain or other thin, elastic, compressive bandage
First, thoroughly lubricate the patient’s finger with a water-soluble lubricant, then use a circular motion with traction to twist off the ring from the finger. Should that fail, try the string method (see below) or use a manual ring cutter.
- The site of maximum diameter (and obstruction to removal) is usually the proximal interphalangeal (PIP) joint.
- Patient comfort with excellent exposure of ring on finger
Step-by-Step Description of Procedure
- First, clean the surrounding skin with a mild antiseptic cleanser such as chlorhexidine.
- Do a proximal digital or metacarpal block to the finger to provide sufficient anesthesia without distending tissue of the finger shaft.
- To decrease edema, first wrap the Penrose drain around the finger from tip to palm. Leave the drain wrapped in place for a few minutes to reach the maximum effect, then remove it.
- Pass about 2 feet of string, umbilical tape, or thick silk suture between the ring and the finger. Use the tip of a hemostat under the ring to grasp the string and pull it through.
- Start the wrapping: Wrap the distal string snugly in a clockwise direction around the swollen finger, beginning at the palm and through to the tip, including the PIP joint and the entire swollen finger.
- Place successive loops of wrap next to each other to keep any swollen tissue from bulging between the strands.
- Once the wrapping is complete, carefully unwind the proximal end of the string in the same clockwise direction to force the ring over that portion of the finger that has been compressed by the wrap. The PIP joint is the area that is most difficult to maneuver over and causes the most pain.
- Alternative method: Wrap the finger with a thin, elastic material instead of the Penrose drain, then slip one end of it proximally underneath the ring. Unwrap the elastic material, proximally to distally.
- Clean any finger lacerations gently with a clean cloth or gauze and soap and water or a mild antibacterial wound cleanser such as chlorhexidine. Suture or bandage with gauze if protection is needed.
Warnings and Common Errors
- Occasionally, the finger must be rewrapped with the Penrose drain then wrapped and unwrapped with string.
- Abrasions or other injuries can result from this procedure.
Tips and Tricks
- Unless the cause is an acute injury, remind the patient to next time remove all rings before finger edema develops and is extensive enough to cause pain or vascular compromise.
- Try a ring cutter when there is excessive swelling or when other methods fail.
- Kalkan A, Kose O, Tas M, Meric G: Review of techniques for the removal of trapped rings on fingers with a proposed new algorithm. Am J Emerg Med 31(11):1605–1611, 2013. doi: 10.1016/j.ajem.2013.06.009
- Asher CM, Fleet M, Bystrzonowski N: Ring removal: An illustrated summary of the literature. Eur J Emerg Med 27(4):268–273, 2020. doi: 10.1097/MEJ.0000000000000658
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