Ring removal techniques
- Joan Bothner, MD
Joan Bothner, MD
- Professor of Pediatrics and Emergency Medicine
- University of Colorado School of Medicine
- Section Editors
- Anne M Stack, MD
Anne M Stack, MD
- Section Editor — Pediatric Procedures
- Associate Professor, Department of Pediatrics
- Harvard Medical School
- Allan B Wolfson, MD
Allan B Wolfson, MD
- Section Editor — Adult Procedures
- Professor of Emergency Medicine
- University of Pittsburgh
Patients commonly present to emergency departments with rings that they are unable to remove from their fingers; often they have tried multiple removal techniques before presenting for care. In addition to rings, children may place metal washers or nuts over their fingers or toes, and teenage and adult males may place various constriction devices around their penis or scrotum to maintain or enhance erection . Etiologies for swelling include trauma, dependent extremity positioning, allergic angioedema, or placement of a ring that is too small for the digit.
Techniques for removing a constricting ring from a finger, toe, or penis are reviewed here.
The ring should be removed as rapidly as possible if the patient has signs of vascular compromise (eg, mottling, absent capillary refill, or gray color).
In addition, removal of rings prior to swelling and entrapment is good basic first aid practice in patients with extremity trauma.
CONTRAINDICATIONS AND PRECAUTIONS
There are no absolute contraindications to ring removal.
- Silberstein J, Grabowski J, Lakin C, Goldstein I. Penile constriction devices: case report, review of the literature, and recommendations for extrication. J Sex Med 2008; 5:1747.
- Ruddy, RM. Illustrated techniques of pediatric emergency procedures. In: Textbook of Pediatric Emergency Medicine, 5th, Fleisher, GR, Ludwig, S, Henretig, FM (Eds), Lippincott, Williams, & Wilkins, Philadelphia 2006. p.1861.
- Baker A, Rylance K, Giles S. The occasional ring removal. Can J Rural Med 2010; 15:26.
- Fuchs, SM. Ring removal. In: Textbook of Pediatric Emergency Procedures, 2nd, Henretig, FM, King, C (Eds), Lippincott, Williams, & Wilkins, Philadelphia 2008. p.1107.
- Greenspan L. Tourniquet syndrome caused by metallic bands: a new tool for removal. Ann Emerg Med 1982; 11:375.
- Schuster G, Stockmal P. Genital incarceration with metal rings: their safe removal. Tech Urol 1999; 5:116.
- Chiu TF, Chu SJ, Chen SG, et al. Use of a Penrose drain to remove an entrapped ring from a finger under emergent conditions. Am J Emerg Med 2007; 25:722.
- Cresap CR. Removal of a hardened steel ring from an extremely swollen finger. Am J Emerg Med 1995; 13:318.
- Fasano FJ Jr, Hansen RH. Foreign body granuloma and synovitis of the finger: a hazard of ring removal by the sawing technique. J Hand Surg Am 1987; 12:621.
- McElfresh EC, Peterson-Elijah RC. Removal of a tight ring by the rubber band. J Hand Surg Br 1991; 16:225.
- Stone, DB, Levine, MR. Foreign body removal. In: Roberts and Hedges Clinical Procedures in Emergency Medicine, 5th, Roberts, JR, Hedges, JR (Eds), WB Saunders Company, Philadelphia 2010. p.650.
- Belliappa PP. A technique for removal of a tight ring. J Hand Surg Br 1989; 14:127.
- Inoue S, Akazawa S, Fukuda H, Shimizu R. Another simple method for ring removal. Anesthesiology 1995; 83:1133.