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.
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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.
Fingertip Injury: Will the Tip of the Finger Grow Back?
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
When to See a Healthcare Provider
You should have your finger checked any time an avulsion occurs, even if there doesn’t seem to be any damage. Call 911 or have someone take you to the emergency department if you’re bleeding a lot or if the finger is completely or partially detached.
Tips for Navigating the ER
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:
- 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.
- 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.
- 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.
Severed Finger: What to Do and When to Reattach
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.
| Class | Avulsion Severity |
|---|---|
| 1 | Blood supply to the finger has not been cut off, and there may or may not be injury to the bone. |
| 2 | Blood supply has been cut off, but there’s no bone injury. |
| 3 | Blood supply has been cut off, and a bone or joint is injured. |
| 4-A | The finger is amputated, and blood supply to the artery is cut off. |
| 4-B | The finger is amputated, and blood supply to veins is cut off. |
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 catheteris 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.
Imaging tests are done to determine the extent of an avulsion and whether or not blood flow is impeded.
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.
First Aid Kits: What You Should Always Have on Hand
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.
Any time blood flow is lost, there is a chance blood vessels won’t function right even after surgery. Even class 2 avulsion injuries can cause circulation problems that lead to the need for amputation.
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 Treat an Avulsion Wound
Recap
A ring avulsion is serious. Sometimes the skin isn’t broken, but internal ligaments, muscle, or even bone and blood vessels are injured. If you don’t get proper medical attention, your finger could be permanently disfigured, or you might lose strength and mobility. In some cases, the blood vessels may be destroyed, and if they can’t be repaired, the finger may need to be amputated.
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.
What Is Occupational Health and Safety?
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.
OSHA Compliance for First Aid in the Workplace
14 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Gopalakrishna A. Avulsion amputation of the ring finger managed by double cross finger flap: 25 years follow-up. Indian J Plast Surg. 2014;47(03):444-446. doi:10.4103/0970-0358.146656
Chiu DTW, Matthew MK, Patel A. The impact of microsurgery on the treatment of ring avulsion injuries. Plast Reconstr Surg. 2019;144(6):1351-1357. doi:10.1097/PRS.0000000000006276
American Academy of Orthopaedic Surgeons. Finger fractures.
National Health Service. Soft tissue injury: finger.
Los Angeles Times. Jimmy Fallon shares gory details of his finger surgery, won't get feeling back after 8 weeks.
Horn A, Freniere B, Sheng AY. A case report of ring avulsion injury: under-recognized for its unique implications in transfer.Clin Pract Cases Emerg Med. 2021;5(1):75-78. doi:10.5811/cpcem.2020.11.49917
Bouz A, Liu Y, Yamaguchi K, Friedrich J. Closed ring avulsion injury with isolated arterial insufficiency. J Hand Surg. 2021 Aug;3(4):1-4. doi:10.1016/j.jhsg.2021.07.004
Hamzan M, Jeffrey M, Halim A, Mat Saad A. Against all odds: traumatic thumb amputation following ring avulsion injury. Pediatr Traumatol Orthop Reconstr Surg. 2020;8(1):95-100. doi:10.17816/PTORS17926
Children's Hospital of Philadelphia. Arteriogram.
Johns Hopkins Medicine. Vascular studies.
Galante JM. Using tourniquets to stop bleeding. JAMA. 2017;317(14):1490. doi:10.1001/jama.2015.8581
C.S. Mott Children's Hospital. Emergency care for an accidental amputation.
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By Jonathan Cluett, MD
Dr. Cluett is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the U.S. national soccer teams.
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