Ring Avulsion Injuries

Ring avulsions are rare injuries in which soft tissue like a ligament, tendon, or muscle is torn loose in the finger when a ring is suddenly and accidentally pulled off. Also called degloving, this could cause a range of problems from mild bruising to damage to bones, blood vessels, ligaments, or nerves.

In rare and extreme cases, a ring avulsion might result in finger amputation. Most people will never experience a ring avulsion, but if you work in a job where you’re more likely to catch your ring, you may be at risk.

This article discusses the causes, symptoms, and risks of ring avulsions. Learn how it’s diagnosed and treated, and how you can prevent this type of injury.

What Is Ring Avulsion?

A ring avulsion occurs when the ring crushes into the finger and is ripped away.

It may not look like there’s much damage, but the finger could be injured beneath the skin. Sometimes, several layers of skin are pulled off during the accident.

If blood vessels are damaged, the blood supply to surrounding tissue can be cut off. In severe cases, you may need surgery to repair blood vessels or tissue.

Symptoms of Ring Avulsion Injury

Getting your ring ripped off is painful. There may be skin damage and bleeding, but it depends on the severity of the injury.

If your finger isn’t bleeding or noticeably injured, watch for other symptoms that can indicate internal damage, such as:

• Swelling of the entire finger
• Discoloration: appearing red or bruised
• Feeling warm
• Numbness and tingling down the finger
• Stiffness and loss of function
• Deformity: fractured or bent in unnatural ways

What Causes Ring Avulsion Injuries?

Ring avulsions are usually the result of an accident, such as a fall or a mistake made when using machinery.

Dramatic stories and studies show that simple accidents can result in serious injuries. Here are three real-world examples of ring avulsion injuries:

1. Surgery to restore blood flow: In 2015, comedian Jimmy Fallon spent 10 days in the ICU because of a ring avulsion. During a six-hour surgery, the doctor performed a graft by taking part of a vein from Fallon’s foot and placing it in his finger. This restored blood flow to the finger.
2. Loss of a finger: A 2020 study reported the case of a machine operator whose wedding band got caught in heavy machinery. His finger was not fractured, but the tendon was stripped from the bone and his blood supply was cut off. Unfortunately, the finger had to be amputated.
3. Internal damage: In another incident, a man slipped on his boat. His ring got caught on the boat as he fell, and he was suspended by his finger for several seconds. Although his finger only looked bruised with minor a cut, imaging tests showed nerve and blood vessel damage. He, too, had a vein graft and 16 months of physical therapy to regain full range of motion.

Diagnosing Ring Avulsion

Doctors diagnose ring avulsion injuries using the Kay classification system. This rates the injury based on blood circulation and skeletal damage. The table below lists the classes from least to most severe.

The main concern is blood flow to and from the finger. If blood flow is cut off, you could lose the finger.

There’s also a risk of arterial thrombosis, a blood clot in an artery. If that were to develop, it would stop blood flow to major organs.

Two tests are usually used to measure blood flow:

• Arteriogram: This is a special type of X-ray that examines your arteries. A radiologist (a doctor who specializes in imaging) performs this test. Your hand will be numbed with local anesthesia or you’ll be made unconscious with general anesthesia. A flexible tube called a catheter is inserted into your arteries. It will release a contrast dye, which will show up on X-ray images. This reveals any breaks or problems in the blood vessels.
• Ultrasound: This non-invasive test measures blood flow by bouncing high-frequency sound waves off of red blood cells in veins and arteries. You don’t need anesthesia for this procedure.

An orthopedic doctor who specializes in hands should examine your finger.

How Is Ring Avulsion Treated?

If you experience a ring avulsion, you need to get medical attention right away—whether you think the injury is significant or not. Never underestimate the potential for blood loss.

Doctors have had success mending serious injuries such as damaged blood vessels and severed tissue. Still, there’s the risk of finger loss in some very extreme cases.

Follow first aid advice to manage any bleeding and help protect your finger from further damage on the way to seeking medical care.

First Aid for Ring Avulsion

If your finger is still intact and you’re bleeding, apply pressure with gauze, bandages, or clean fabric like a T-shirt or towel.

Only try to remove the ring if it can easily slide off without causing more pain or injury. Forcing the ring to come off when there’s swelling or skin degloving can make the injury worse.

If your finger has been amputated:

• Call 911 or have someone take you to the ER.
• Apply pressure to stop the bleeding and keep your hand elevated above your heart.
• Have someone help you wash the detached finger with clean water.
• Wrap the detached finger in dry gauze and put it in a sealed bag or waterproof container.
• Keep the bag or container on ice until you reach the ER. Don’t place the finger itself directly on ice.
  

Surgery

Ring avulsion injuries usually require microvascular reconstruction surgery. For class 1 injuries, doctors will focus on closing open wounds and repairing tendons or muscles. For class 2 and higher, a hand surgeon or plastic surgeon will use tiny instruments to reconnect broken blood vessels and restore blood flow. Broken bones may also need to be reset.

If the injury falls within class 3, there’s still a possibility your finger can be reattached. Before trying that, your surgeon will consider how much damage has been done to the soft tissues and how likely it is that you’ll regain function.

It is far less likely that a class 4 amputated finger will be reattached. However, following the first aid guidelines to protect the detached finger en route to the hospital increases the chances that a surgeon will be able to reattach it.

How to Prevent Ring Avulsion Injuries

There are steps you can take to prevent ring avulsion injury. Some of these are required in some workplaces.

Remove Your Rings

Remove rings before working, especially if your job involves harsh or slippery conditions, heavy machinery, or anything that puts you at risk of falling.

It’s also smart to remove rings before doing home improvements or yard work, playing sports, exercising, or enjoying hobbies. It’s especially important if you know you’re prone to accidents.

Wear a Silicone Ring

Rings made of silicone have become popular. These inexpensive bands are designed to break if they get snagged on an object. Some brands combine precious metals with the silicone to give them a sense of style and rarity. Others are made specifically for outdoor enthusiasts and people with active lifestyles.

Summary

Ring avulsion injuries are rare but can be very serious. They’re usually caused by accidents in the workplace or during physical labor. A ring gets caught on something and quickly pulls the finger, resulting in anything from severe bruising to amputation.

Even if your finger looks fine, it’s important to have it checked by a healthcare provider. Don’t delay medical attention. The moment an avulsion occurs, you should call 911 and start first aid right away.