Ring Avulsion

Overview

What is a ring avulsion?

A ring avulsion is an injury to one of your fingers that happens when a ring you’re wearing is suddenly pulled with a strong force. They are serious injuries that frequently lead to amputation.

The most common causes of ring avulsions are workplace accidents, falls and sports injuries. How long it takes to recover form a ring avulsion depends on what caused it and how severely damaged your finger is.

Who gets ring avulsions?

Anyone wearing a ring can experience a ring avulsion. If you wear a ring and work with your hands around machinery or other equipment you have a higher risk of experiencing a ring avulsion.

Athletes who wear rings while playing sports — especially contact sports like football — have a higher risk too.

How common is this condition?

Ring avulsions are rare. They’re only around 5% of emergency room visits for arm and hand injuries each year.

How does this condition affect my body?

Depending on how severe the ring avulsion is, it can cause a lot of damage to your finger. Ring avulsions can be traumatic injuries that require a finger amputation. The damage can also cause blood clots and bone fractures in your damaged finger.

Ring avulsions can damage any part of your finger including your:

  • Skin and surrounding soft tissue (like muscles and fat).
  • Nerves.
  • Blood vessels.
  • Tendons.
  • Bones.

Symptoms and Causes

What are the symptoms of a ring avulsion?

Symptoms of a ring avulsion include:

  • Part or all of your finger pulled off.
  • Pain.
  • Bruising or discoloration.
  • Trouble moving or using your finger the way you usually can.

What causes ring avulsions?

Ring avulsions can be caused by any force that pulls on your ring hard enough to damage your finger.

Common causes include:

  • Workplace accidents (like getting your ring caught in a machine or equipment).
  • Falls (like catching your ring on a fence or the edge of a counter).
  • Sports injuries (such as getting your finger pulled during a football tackle).

Diagnosis and Tests

How are ring avulsions diagnosed?

Your healthcare provider — or providers in the emergency room — will diagnose a ring avulsion with a physical exam and imaging tests. They will look at your finger and see if it’s still receiving any blood circulation.

What tests are done to diagnose ring avulsions?

Your provider might use imaging tests like X-rays or an ultrasound to assess the damage to your finger. These tests will give them a complete picture of your finger and all its bones and tissues. This will help them diagnose other damage like bone fractures or blood clots.

Ring avulsion classification

Your provider will use a scale called Urbaniak classification to define the severity of your ring avulsion:

  • Class 1 (least severe): Adequate blood circulation and ability to move your finger.
  • Class 2 (moderate): Not enough blood circulation and difficulty moving your finger.
  • Class 3 (complete avulsion): No circulation and your finger has been pulled off.

Ring avulsions may also be referred to as involving degloving (pulling your skin and soft tissue off your bone).

Management and Treatment

How are ring avulsions treated?

Almost all ring avulsions require surgery. Which type of operation you’ll need depends on the classification of the ring avulsion and how severely damaged your finger is. If it’s possible, your surgeon will reattach your finger and restore its blood flow and function. Many people with class 3 avulsions require permanent amputation.

In addition to reattaching your finger, your surgeon might need to perform a skin graft around your finger to repair the avulsion’s degloving.

How soon after treatment will I feel better?

How long your recovery will take depends on which type of ring avulsion you had any other damage to your finger you experienced. It can take anywhere from several weeks to more than a year before you’ll be able to use your finger again. Talk to your surgeon or provider for a specific healing timeline.

Prevention

How can I reduce my risk?

Don’t wear rings or other jewelry while working with tools or heavy equipment. Always be aware of your surroundings, and — if possible — take your rings off before doing anything that might be dangerous.

Make sure any rings you do wear aren’t loose on your fingers. The looser a ring fits, the more wiggle room it has to get caught on something while you use your hand.

Does wearing a silicone ring prevent ring avulsions?

There’s some evidence that wearing a silicone ring can prevent ring avulsions. Silicone rings and wedding bands have become more popular in the last few years. Because this is a relatively new trend, experts are still studying it.

Silicone rings break or tear easier than metal rings. This means a silicone ring should break before your finger can get pulled with enough force to injure it.

Outlook / Prognosis

What can I expect if I have a ring avulsion?

Ring avulsions are serious injuries. You should expect a long recovery time, and you might never be able to use your finger the way you could before the injury. There’s also a chance your finger will need to be amputated.

Will I need to miss work or school with a ring avulsion?

You’ll probably need to miss some work or school while you’re recovering. Talk to your surgeon or healthcare provider about when you can resume working or other physical activities after a ring avulsion.

Outlook for this condition

Ring avulsions are rarely life-threatening injuries, but there’s a good chance that a ring avulsion will permanently affect how you use your hand.

Living With

When should I go to the emergency room?

Go to the emergency room right away if you’ve experienced a ring avulsion or any other trauma. If your finger was removed during the injury, bring it with you to the ER. Don’t put it directly on ice.

What questions should I ask my doctor?

  • Which class of ring avulsion do I have?
  • Will I need an amputation?
  • Did I experience any other injuries?
  • When will I be able to use my finger again?

A note from Cleveland Clinic

Ring avulsions are serious injuries. Fortunately, they’re rare. Even if you need an amputation or lose part of your finger, a ring avulsion isn’t usually a life-threatening condition. The best way to avoid a ring avulsion is to prevent one from happening. Take your rings off before doing any activity that might cause your fingers to get caught or pulled.

Last reviewed by a Cleveland Clinic medical professional on 01/31/2022.

References

  • American Association for Hand Surgery. Avoiding ring avulsion injuries with silicone rings: a biomechanical study. (https://meeting.handsurgery.org/abstracts/2021/ODP-Trauma23.cgi) Accessed 1/13/2022.
  • Bamba R, Malhotra G, Bueno RA Jr, Thayer WP, Shack RB. Ring Avulsion Injuries: A Systematic Review. (https://pubmed.ncbi.nlm.nih.gov/28720047/) Hand (N Y). 2018 Jan;13(1):15-22
  • Jones M, Gujral S. Ring Avulsion Injuries. (https://pubmed.ncbi.nlm.nih.gov/26933469/) Eplasty. 2016 Feb 10;16:ic5.

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