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

• Hemostat

• String, umbilical tape, or thick silk sutures

• 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

• Do 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.

• Pass one end of about 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.

• 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 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.

• Occasionally, the finger must be rewrapped with the Penrose drain then wrapped and unwrapped with string.

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

• Abrasions or other injuries can result from this procedure.

• 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.

• Try a ring cutter when there is excessive swelling or when other methods fail.

1. 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 31(11):1605–1611, 2013. doi: 10.1016/j.ajem.2013.06.009

2. Asher CM, Fleet M, Bystrzonowski N: Ring removal: An illustrated summary of the literature. Eur J Emerg Med 27(4):268–273, 2020. doi: 10.1097/MEJ.0000000000000658