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10.05 Ring Removal


Presentation

A ring has become tight on the patient's finger after an injury (usually a sprain of the proximal interphalangeal or PIP joint) or after some other cause of swelling, such as a local reaction to a bee sting. Sometimes, tight-fitting rings obstruct lymphatic drainage, causing swelling and further constriction. The patient usually wants the ring removed even if it requires cutting it off, but occasionally a patient has a very personal attachment to the ring and objects to its cutting or removal.

What to do:

What not to do:

Discussion:

The constricting effects of a circumferential foreign body can lead to obstruction of lymphatic drainage, which in turn leads to more swelling and further constriction, until venous and eventually arterial circulation is compromised. If you believe that these consequences are inevitable you should be quite direct with the patient about having the ring removed.

References:


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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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