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Background
Upper limb injury or infection can cause swelling or dependent oedema in fingers and this may be further complicated by the presence of a ring. Patients often present to accident and emergency (A&E) whereby these rings can be removed; however, this may be difficult with a late presentation.
We report an unusual case in a psychiatric patient with a delayed presentation of a swollen digit and hope to highlight the difficulties to emergency care practitioners.
Case presentation
A 49-year-old man presented to the emergency department with a partially embedded ring on the volar aspect of the left index finger ( figures 1 and 2 ). The patient was known to the mental health team suffering from a long history of schizophrenia and depression.
Three months prior to his presentation, he had noticed a small cut on the left index finger; however, he did not seek medical attention. He subsequently developed swelling of the finger, which deteriorated over the following months. His attendance to A&E was triggered by increased pain and the inability to flex the finger.
Clinical examination of the left index finger revealed a grossly swollen digit surrounded by erythema. On the volar aspect of the finger, the ring was not visible as it was completely embedded within the skin. Capillary refill was delayed at 5 s with complete parasthesia of the left index finger. Flexion distal to the metocarpophalangeal joint was not possible indicating dysfunction of flexor digitorum superficialis and flexor digitorum profundus tendons.
Traditional methods to remove the ring would have...