Trigger finger is a common condition in which a finger gets stuck in a bent position and then suddenly straightens with a snap. It results from inflammation or thickening of the flexor tendon sheath at the A1 pulley. Usual treatments include splints, hand therapy, and steroid injections, with surgery reserved for stubborn cases. More recently, percutaneous trigger finger release has emerged as an alternative to open surgery, with excellent outcomes and a faster recovery. This guide explains how percutaneous trigger finger release works, what the procedure involves, and what the research shows.
This is the next step after a trigger finger injection when one or two injections haven’t worked — see our companion guide for the first-line treatment.
What is percutaneous trigger finger release?
Percutaneous trigger finger release frees the A1 pulley by passing a needle through the skin. The aim is to let the flexor tendon glide freely again by releasing the constricted pulley. Unlike open surgery, which requires an incision and tissue cutting, the percutaneous technique uses ultrasound guidance to ensure precision and safety.
How is the procedure performed?
We carry it out in a sterile treatment room under local anaesthesia.
- The skin over the palm, near the base of the affected finger, is cleaned and numbed with local anaesthetic through a tiny needle.
- A larger needle is then passed through the skin, guided by ultrasound, to reach the A1 pulley
- The pulley is released with a controlled series of needle passes—typically around 10.
- A dressing is applied.
- Gentle finger movement starts after 24 hours to maintain tendon glide, with ice and oral anti-inflammatories to reduce swelling. Heavy gripping usually resumes after a week.
Ultrasound guidance shows the cutting in real time, reducing the risk of injuring nearby tendons, nerves, or vessels.
Evidence for percutaneous trigger finger release
Several studies show percutaneous release is as effective as surgery for most people, with less pain and faster recovery.
- A 2012 meta-analysis in The Journal of Hand Surgery found similar long-term success (over 90%) to that of en surgery, with a significantly lower complication rate and a quicker return to activity.
- In trained hands, the recurrence rate is low.
Surgeons may still prefer open surgery for complicated cases, but percutaneous release is increasingly the first invasive option after hand therapy and a cortisone injection.
Risks of percutaneous trigger finger release
Though generally safe, the procedure carries some risks:
- Injury to the digital nerve or artery — more relevant in the thumb or little finger
- Incomplete release or recurrence
- Local tenderness or bruising at the puncture site
- Infection (rare — about 1 in 10,000)
Using ultrasound guidance and an experienced clinician keeps complications to a minimum.
Frequently asked questions about percutaneous trigger finger release
Is a trigger finger injection the same as a percutaneous release?
No. A trigger finger injection is a cortisone injection with local anaesthetic that shrinks the A1 pulley and improves tendon gliding — effective in 70–90% of cases. A percutaneous release is more definitive: it physically releases the A1 pulley and tends to be more effective for pain and function in cases where injections haven’t helped.
When should I choose a percutaneous release over another injection?
We usually recommend a cortisone injection first, since many people get a complete cure from it. If one or two injections fail, a percutaneous release is the logical next step — more definitive than a third injection and far less invasive than open surgery.
How long is the recovery after percutaneous trigger finger release?
Quick. Gentle movement starts the next day, and most people return to heavy gripping after about a week, considerably faster than open surgery.
Is percutaneous release better than open surgery?
For most people, it offers similar success (over 90%) with fewer complications and faster recovery. Open surgery is reserved for complicated cases or where a percutaneous release hasn’t fully worked.
Does percutaneous trigger finger release hurt?
The area is first numbed with local anaesthetics, so the procedure itself is well tolerated. Some tenderness or bruising at the puncture site afterwards is normal and settles quickly.
Final word from Sport Doctor London about percutaneous trigger finger release
Percutaneous trigger finger release is a safe, effective option for persistent finger locking that hasn’t responded to conservative treatment. It offers outcomes similar to surgery, with fewer complications and a faster recovery. If you have trigger finger and conservative treatment — including one or two injections — hasn’t worked, ask a sports medicine doctor whether a percutaneous release suits your case.
To book an assessment with Dr Masci in London, contact the team here or call +44 (0) 203 488 0350.
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