How to Remove a Tight Ring

How to Remove a Tight Ring

John C. Elfar

David J. Ciufo


  • Constrictive rings are a common problem encountered in acute care settings.

  • A tight ring may occur either in isolation or in the setting of trauma.

  • Constricting items may include metal hardware (nuts and washers) in addition to jewelry.

  • Patients often try home-based methods of removal before presentation.

  • The hand is often the dependent portion of the upper extremity, predisposing it to swelling in the setting of trauma or edema due to medical diagnoses.

  • Edema coupled with outflow obstruction leads to a cycle of increasing venous congestion.

  • Arterial obstruction can lead to digital ischemia in severe cases.

  • Rings should prophylactically be removed in the setting of upper extremity trauma.


  • Identification of potentially constricting jewelry is a critical first step in the setting of trauma.

  • Previous attempts at removal and duration of constriction are important elements of a thorough history.

  • Neurologic and vascular examination of the entire extremity is critical, along with documentation of the examination findings, before and after removal of constricting devices.

  • A focused neurologic and vascular examination of the affected digit should be performed.

  • The type of material causing constriction may affect the management (soft vs. hard metal vs. ceramic or stone).


  • Attempts to remove a ring are sometimes destructive of the ring itself, and patients should be warned of this possibility.

  • If vascular status is compromised (absent capillary refill, mottling of the digit), the ring should be removed emergently.

  • Provide a field block if indicated for the patient to better tolerate removal.

    • This should be avoided if removal methods would benefit from protective sensation for feedback from the patient.

    • Injection of local anesthetic should be performed with caution because this could add fluid and increase swelling of the affected digit.

  • Efforts should be made to repeat imaging studies after removal to avoid missed injuries to the affected digit.

  • Rings should never be left in place under splints or other forms of immobilization.

  • Avoid intravenous access in an injured extremity when possible.


Edema Management

  • Compression of the entire digit by wrapping it with an elastic tourniquet (such as those used for intravenous access) may be used to reduce edema.

  • Ice and elevation may be sufficient to reduce minor edema and allow the ring to slide off.

  • These are some of the simplest methods and often have been attempted before presentation in isolated tight-ring situations.


May 7, 2019 | Posted by in ORTHOPEDIC | Comments Off on How to Remove a Tight Ring
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