WhiteCoat

With This Ring …

What do you do when you can’t get a ring off your finger?

I learned a trick in medical school that always stuck with me and I got to use it again a few days ago with another mark in the “success” column.

About 5 or 6 times per year we see someone who can’t get their ring off. The patient puts the ring on when the finger is small and then some event makes the finger larger so the ring gets stuck.

So was the story of the patient that we saw. She was very upset at the thought of having her grandmother’s wedding ring cut off, but her finger was so swollen that the ring was stuck.

So how do I get a ring off of a swollen finger?  Here’s my secret trick:

You’ll need some lubrication (vaseline or something similar) and a rubber tourniquet. A large rubber band or even a shoelace might work in a pinch. If you know how to do one, performing a digital block may keep the patient out of pain.

Starting at the top of the finger and winding your way down, wrap the rubber band/tourniquet tightly around the finger so that it squeezes all of the blood out of the finger.

Leave the tourniquet on the finger for about 10 minutes.
Take the tourniquet off and immediately lube up the ring and entire finger.

There are two ways to work the ring off. My preferred method is to untwist the ring like a bottle cap – pulling the ring off while twisting. I have also seen the “rocking” method where the ring is rocked back and forth while pulling it off. Personally, I have had more success with the first method.

Any other ideas for saving the rings from the evil ring cutters?

24 Responses to “With This Ring …”

  1. Jon says:

    I have used waxed dental floss instead of the tourniquet, often you don’t even need the lube. The tape style works the best as the other may cut into a swollen finger.

  2. Graham says:

    Was actually just reading this in Tintanalli, as luck would have it. Another method is to string some silk suture under the ring, then slowly start wrapping it distally around the finger tightly. Then, as you unravel the proximal end of the string (that’s under the ring), you work the ring off at the same time. Apparently synthetic suture is more likely to cut the skin.

  3. Irish-RN says:

    Umbilical tape: work one end under the ring and wind the tape around the distal end of the finger, compressing the tissue. Pull the end that was worked under the ring and it will work it’s way up the finger.

  4. TK says:

    I have used string – but unfortunately rarely with success. Most cases of rings being too tight are in situations where the finger is broken and REALLY swollen and cutting is the only way. Often you can make two clean cuts and the ring can be repaired assuming you don’t bend the hell out of it.

    Good point – pulling a ring over a broken or dislocated finger probably isn’t a good idea. Then you’re stuck with the ring cutter.

  5. scalpel says:

    I just have the patient elevate it while I squish the finger with my hand, I’ve never been a fan of the tape/string stuff. I then use the rocking method to work some of the swollen finger tissue past the ring and alternate with the twirling and pulling method, using lots of lube. I’ve never used a digital block for one of these.

    Using the ring cutter makes me feel like I failed, which happens less than 10% of the time, I would estimate.

  6. HyperAl says:

    I’ve used 1/4 in. iodoform gauze because it is sturdy and thin and very unlikely to cut the skin. If it does, hey, you have iodine there already. You’re ahead of the game.

  7. Jill says:

    Whoa, that hand looks so red and swollen – ouch! Not so sure about this method from the looks of it WhiteCoat :(

    Hey – that’s MY hand. I was just doing the pictures at my desk using my hand as an example to demonstrate the technique. The redness is just the exposure from the camera. My complexion is more a fishbelly white.

  8. Moshe says:

    My daughter once put a heavy and thick nut on her index finger. Tried everything – couldn’t get it off. We had to work on it for 50 minutes with a ring cutter – it needed to be cut in 2 places to be removed.

    Not fun.

  9. BlackSails says:

    Couldnt you just use a warm water salt bath?

    Salt water = hypertonic to the finger, causing it to shrink a bit.

    Warm water causes the ring to expand.

    • Katharine says:

      You are a LIFE SAVER! I had this ring that had made my finger green, and huge over night, i tried this doctors method with the gauze, didnt work either. Swelled up even more. I tried lotion, windex, nothing was working. So I read your method, Filled my sink up with warm salty water and with in seconds, it was off my finger! Thank you!

  10. Chrys says:

    I’ve used dental tape, because it was strong. I’d slide it under the ring and then continued to rotate it using a little soap and water. Interesting to see the different methods.

  11. ekchung says:

    @BlackSails: Saltwater or fresh water will make little difference to a finger. The skin is relatively impermeable to water, so the tonicity of whatever it’s sitting in won’t make a difference. Ever try to quench your thirst by taking a shower? Didn’t think so.

    Temperature, however, WILL make a difference, but not in the way you would want it to. True, warm water will make the ring expand slightly, but the difference is far from significant. What the warm water will do, though, is cause the capillaries in the finger to dilate, INCREASING the size of the finger, and making the situation more difficult all around. If you’re going to soak the finger, best to do it in ice water (with a pressure dressing, while the hand is elevated above the heart).

  12. ekchung says:

    Oh – and two tips:

    Since the cross-section of a finger is a little trapezoidal, I’ve found it more productive to try to push a stuck ring in the dorsal direction while pulling distally. That way you’re pushing the widest part of the ring towards the widest part of the finger, giving you as much room as possible.

    And one tip for a good finger wrap (although I’ve never had to use it myself): plumber’s teflon tape. It’s super thin, so you don’t have to remove it before trying to pull off the ring. It also provides a bit of lubrication by itself. Of course, it’s not stocked in our Pyxis.

  13. Health Guru says:

    Good post as I’m sure I’ll run into this problem later in life!

  14. halfmd says:

    Great tip. I’ll have to keep in mind.

  15. GingerB says:

    We used dental floss on MIL’s stuck ring. We threaded the floss under the ring, wrapped it fairly closely and then pulled on the end under the ring to work it off. The wrapping pushed the fluid in her finger around enough that it slipped off.

    We’d seen her Sunday and noticed that her hand had swollen. Wednesday the nursing home called and said they were going to send her to the ER to remove it. Our health plan sent us a book with all kinds of “things to try before calling us” hints and the dental floss trick was one of them. We always got a bill for $500 when she went places by ambulance so it seemed like it was worth a shot.

    We went over and did it. Despite our wrapping and some fairly vigorous tugging she hardly roused. I took the ring home and put it in a box with FIL’s ring thinking that now the two rings were together. The next evening we got a call that she’d passed.

    I felt like once the ring was off her finger she was free to go and be with him in the hereafter. That was my last experience with her in this world.

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  17. snowland202 says:

    Cool!

  18. acountrydoctorwrites says:

    I have used string in similar cases, and on a couple of occasions I have used petrolatum gauze in a similar fashion to reduce paraphimosis.

    http://acountrydoctorwrites.wordpress.com

  19. SeaSpray says:

    All very interesting! :)

  20. geena says:

    Coban also works great for this (sticky ACE wrap)

  21. MM says:

    “Hey – that’s MY hand. I was just doing the pictures at my desk using my hand as an example to demonstrate the technique.”

    Note to self: even if he posts the picture of a cyclope with a wart on its chin, make sure not to make any derogatory comment. ;-)

  22. rogue medic says:

    A lot of good ideas. It has been a long time since I had a patient with ring removal issues, but I will try some of this out when I get another one.

  23. peskypixies says:

    My jeweler uses Windex. Works nearly every time. You just squirt it on the area, move the ring around a bit, and pull it off. Might take a few tries, don’t irritate it too much.

    My hands had swollen quite a bit, and I thought I would have to have my wedding band cut off. I literally went from my normal 4 1/4 to a 5 1/2 within a few weeks. But, the ring came off, and in one piece. Has also worked when they have been sizing me with my tiny fingers and those lop sided heavy weighted ring sizers just make it harder… I can’t believer I ever put on a 4 and got the thing off (though when I was 19 I wore a 3 1/2, I’m 27 now…).

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