How To Remove a Ring Using the String Method

• Edema or anticipated edema when ring will not slide off finger

Absolute contraindications

• None

Relative contraindications

• Lacerations and fractures of the finger

• Finger deformity or arthrosis distal to the ring

• Laceration of underlying tissue

• Digital nerve injury

• Nonsterile gloves

• Soap or water-soluble lubricant

• Mild antiseptic cleanser (eg, 2% chlorhexidine)Mild antiseptic cleanser (eg, 2% chlorhexidine)

• Hemostat

• String, umbilical tape, or thick silk sutures

• Local anesthetic (eg, 1% lidocaine)Local anesthetic (eg, 1% lidocaine)

• 25- or 27-gauge needle

• 10-mL syringe

• Penrose drain or other thin, elastic cord (eg, strap from a nonrebreather mask)

First, thoroughly lubricate the patient’s finger with soap or a water-soluble lubricant, then use a circular motion with traction to twist off the ring from the finger. Should that fail, try placing the patient's hand in ice water for several minutes and then use soap or a water-soluble lubricant again. If those methods fail, try the string method or use a manual ring cutter.

• The site of maximum diameter (and obstruction to removal) is usually the proximal interphalangeal (PIP) joint.

• Patient comfort with excellent exposure of ring on finger

• First, cleanse the surrounding skin with a mild antiseptic cleanser such as chlorhexidine.First, cleanse the surrounding skin with a mild antiseptic cleanser such as chlorhexidine.

• Perform a proximal digital nerve block or metacarpal block to the finger to provide sufficient anesthesia without distending tissue of the finger shaft.

• To decrease edema, first wrap the Penrose drain around the finger from tip to palm. Leave the drain wrapped in place for a few minutes to reach the maximum effect, then remove it.

• Alternatively, wrap the finger from the distal phalanx towards the metacarpophalengeal joint with a thin, elastic cord (eg, strap from a nonrebreather mask) instead of the Penrose drain, then slip one end of it proximally underneath the ring. Leave in place for a few minutes, then unwrap the elastic cord, proximally to distally.

• After the edema has been decreased, sometimes the ring can be removed.

• If the ring still cannot be removed, pass one end of approximately 2 feet of string, umbilical tape, or thick silk suture between the ring and the finger. Use the tip of a hemostat under the ring to grasp the string and pull it through (1).

• Start the wrapping: Wrap the distal string snugly in a clockwise direction around the swollen finger, beginning at the palm end next to the ring and continue through to the tip, including the proximal interphalangeal (PIP) joint and the entire swollen finger.

• Place successive loops of wrap right next to each other to keep any swollen tissue from bulging between the strands.

• Once the wrapping is complete, carefully unwind the proximal end of the string that is tucked under the ring in the same clockwise direction to force the ring over that portion of the finger that has been compressed by the wrap. The PIP joint is the area that is most difficult to maneuver over and causes the most pain.

• Cleanse any finger lacerations gently with water or saline (2). Suture or bandage any wounds as needed.

• A Penrose drain or elastic cord is usually too flexible to pull the ring off and is used to decrease the edema.

• Abrasions or other injuries can result from this procedure.

• Occasionally the process of wrapping the finger with a Penrose drain or elastic cord, removing the wrap, and rewrapping will need to be repeated to decrease the edema for successful ring removal.

• Unless the cause is an acute injury, remind the patient to next time remove all rings before finger edema develops and is extensive enough to cause pain or vascular compromise.

• A ring cutter is used when there is excessive swelling or when other methods fail (3).