How to Remove an Entrapped Ring
65 year old female presents for 4th digit swelling and pain after trying to remove her ring, realizing that it will not slide off. She doesn't care about the ring and doesn’t mind you cutting it.
40 year old male who presents for the same complaint, however he really cares about the ring and does not want you to break the ring.
21 year old male who presents for pain and swelling on his penis after placing a ring to maintain and erection. He is embarrassed so he presents after the ring has been in place for 48 hours.
5 year old female who was going through dad’s tool box, presents to the ED with a washer stuck on her finger
How do you approach these cases?
Before Ring Removal
Determine how long the ring has been on the digit or external genitalia, the composition of the ring, and removal methods already attempted
Treat infections and allergic reactions in a timely manner if these are the cause of the swelling and entrapment
Quickly remove rings when signs of ischemia are present (e.g. delayed capillary refill)
If necessary perform a digital or penile block. Remember to avoid lidocaine containing epinephrine
Elevating the extremity and using ice can help reduce the edema
Methods of Removal
Methods that involve breaking the ring
Remember that this generates heat and it can burn the skin
Drip ice water onto the ring in order to prevent burns
If the ring is made of steel, titanium, or tungsten carbide, ring cutters will not work
Raptors Leatherman shears
Dental Drill, electric saw, Dremel motor saw
Use these tools for steel, titanium, or tungsten carbide rings
These tools are also needed for objects other than rings like washers and nuts that often involve pediatric patients
Sometimes two cuts may be necessary in order to remove the ring
Locking pliers or vise grip for tungsten carbide rings
Tungsten carbide is tough but brittle
Methods for intact ring removal
Two strings method
Philip Siva Vittozzi Wong, MD is a current third year resident at Stony Brook Emergency Medicine.
All of the material presented is explained with pictures in the references below. There is also an algorithm that will help you treat this condition with efficiency.
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. 2013 Nov; 31(11):1605-11.
UpToDate - Ring Entrapment and Removal - https://www.uptodate.com/contents/ring-entrapment-and-removal
Edited by Bassam Zahid, MD