A Novel Method of Ring Removal From the Aging Finger (2024)

Abstract

A simple, inexpensive method for removal of a ring from a swollen finger in elderly patients is described. This technique is similar to application of an Esmarch bandage prior to a surgical procedure. The technique uses a sheet rubber blood-drawing tourniquet, a hemostat, and a lubricant. In over 250 cases, this method has failed only once and no complications have been noted.

Keywords: edematous finger, geriatric patients, ring finger, ring removal, upper extremity surgery

Introduction

A ring may present as a problem for the geriatric orthopedic patient visiting the emergency department, operating room, or hospital setting. The ring can become troublesome when the finger that bears it is swollen, preventing easy ring removal. This may happen as a consequence of aging and time. Trauma to the hand or upper extremity may cause the finger to swell and make the ring difficult to remove. Because the ring is often of great sentimental value to the patient, cutting it may be undesirable. Ring cutters are found in most clinical settings and orthopedic surgeon’s clinics for this purpose. This article covers a technique of ring removal that has been used by the author for the past 25 years with great success.

Many techniques have been described for ring removal, including lubricating the finger, use of threads and sutures, compression with blood pressure cuffs and penrose drains, and cutting the ring with a ring cutter.^1-10 The new method described below uses readily available items to remove the ring. Thus, the cost is minimal and the success rate has been greater than 99% in the author’s practice.

Materials and Methods

Materials required for ring removal: 1-inch by 12-inch (25 mm by 300 mm) sheet rubber blood-drawing tourniquet, a hemostat clamp, and a gel lubricant (Figure 1).

Technique: The technique is similar to application of an Esmarch bandage prior to a surgical procedure. The rubber blood-drawing tourniquet is wrapped in a sequential, circumferential manner beginning at the fingernail and progressing proximally until the finger is entirely wrapped in a fairly tight manner over the course of the finger. The tourniquet is then clamped to itself with the hemostat clamp (Figure 2). Ten minutes are allowed to elapse. The physician or an assistant should be present while the rubber bandage is in place to reassure the patient. The physician or assistant must monitor the patient by assessment of pain and symptoms during the time the rubber bandage is in place.

Lubricant is then prepared and the blood-drawing tourniquet is removed rapidly. The lubricant is applied to the finger and the ring can then be readily slid off the finger. The tourniquet’s method of action is to diminish the swelling, edema, or puffiness to the finger preventing normal ring removal.

Results

This technique has been used with great success by the author for 25 years with only 1 failure, which was caused by an enlarged arthritic proximal interphalangeal (PIP) joint of the ring finger. No complications with this technique have been noted by the author in over 250 uses.

Discussion

Because it is a simple technique, it should be considered in clinical situations requiring intact ring removal. An inexpensive ring or one of no sentimental value may be readily removed using the ring cutter.

Disadvantages to this technique include mild-to-moderate discomfort experienced by the patient during the compression phase. The hemostat should be large enough so that it is not mistakenly left on too long or finger ischemia could potentially occur. The patient should be informed that the procedure may be occasionally repeated if the finger is very swollen. This technique may fail if the PIP joint is very hypertrophied from arthritic changes. Most patients who have had their ring removed successfully have been pleased to save their prized possession and have expressed gratitude.

Contraindications to this technique include a fractured ring finger, an ischemic finger, or one with open wounds. Another potential pitfall would likely occur if the patient has a chronic pain syndrome affecting this hand.

Footnotes

References