Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point-of-care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors and editors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

Choose from the list below to learn more about subscriptions for a:


Subscribers log in here


Ring removal techniques

INTRODUCTION

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 [1]. 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.

INDICATIONS

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.

          

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Jul 2014. | This topic last updated: Jul 28, 2014.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
References
Top
  1. 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.
  2. 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.
  3. Baker A, Rylance K, Giles S. The occasional ring removal. Can J Rural Med 2010; 15:26.
  4. Fuchs, SM. Ring removal. In: Textbook of Pediatric Emergency Procedures, 2nd, Henretig, FM, King, C (Eds), Lippincott, Williams, & Wilkins, Philadelphia 2008. p.1107.
  5. Greenspan L. Tourniquet syndrome caused by metallic bands: a new tool for removal. Ann Emerg Med 1982; 11:375.
  6. Schuster G, Stockmal P. Genital incarceration with metal rings: their safe removal. Tech Urol 1999; 5:116.
  7. 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.
  8. Cresap CR. Removal of a hardened steel ring from an extremely swollen finger. Am J Emerg Med 1995; 13:318.
  9. 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.
  10. McElfresh EC, Peterson-Elijah RC. Removal of a tight ring by the rubber band. J Hand Surg Br 1991; 16:225.
  11. 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.
  12. Belliappa PP. A technique for removal of a tight ring. J Hand Surg Br 1989; 14:127.
  13. Inoue S, Akazawa S, Fukuda H, Shimizu R. Another simple method for ring removal. Anesthesiology 1995; 83:1133.