EPSON DSC pictureA patient presents with a swollen finger after falling and fracturing it. The patient is more distraught by the fact that she can’t get the ring off her finger. She implores you not to cut the ring off.

There are textbook chapters written about tightly wrapping the digit with string from distal-to-proximal and sliding the string under the ring. Theoretically, the provider can pull and unwind the proximal end of the string to gradually coax the ring over the coils of string.

I have personally found little luck with this maneuver.

 

Trick of the Trade

Tourniquet-wrap the entire finger

Tourniquet

The basis of all techniques for ring removal involves reducing the edema distally in the finger. Tightly wrap the finger in a distal-to-proximal direction using a rubber tourniquet, typically used for phlebotomy.  In fact, wrap over the ring itself as well. With a cooperative patient, have him/her hold the proximal end taut for 15 minutes. This may require a digital block for pain control. Keep the hand elevated.

After 15 minutes, unwrap the tourniquet, apply generous lubricant on the finger, and remove the ring in a twisting or rocking fashion. You can repeat the tourniquet wrapping if you are unsuccessful the first time.

Thanks to Dr. Patricio Chavez (emergency physician at Sutter Delta in Antioch, CA) for this trick, who tells me that he “can’t remember the last time he had to cut a ring off” since using this typically successful technique.

 

Michelle Lin, MD
ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco
Michelle Lin, MD

@M_Lin

Professor of Emerg Med at UCSF-Zuckerberg San Francisco General. Founder of ALiEM @aliemteam #PostitPearls https://t.co/7v7cgJqNEn
Michelle Lin, MD