What is Trigger finger?

Trigger finger is a condition characterized by clicking or locking of the finger during finger movement. Catching of the tendon can occur due to inflammation or swelling of the tendon or the fibrous bands (“pulleys”) that hold the tendons close to the bone. The most common site of triggering occurs at the A1 pulley.

*Reproduced from JF Sarwak, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010.

Do you suffer from Trigger finger?

Trigger finger is one of the most common causes of hand pain.

Pain when you bend or straighten the finger
A tender lump at the base of the finger on the palm side of the hand
Catching, popping, or locking sensation during finger movement
Symptoms often more severe in mornings or after periods of inactivity

How is Trigger Finger Traditionally Treated?

Treatment Options:

Non-Surgical

Rest from activities that worsen symptoms
Splinting at night
Stretching exercises
NSAIDs
Steroid/Cortisone injections

Open Surgery

Incision is made over the A1 pulley to cut and release the A1 pulley blocking tendon movement
Typically performed in an outpatient surgery setting

Ultrasound Guided Percutaneous release

Minimally invasive procedure performed in the physician office to release the A1 pulley under ultrasound guidance

Learn More

Percutaneous Trigger Finger Release

Percutaneous trigger finger release is minimally invasive and offers a quicker recovery.

Benefits Include¹

Most patients can return to work and the activities within 3-6 days
Performed in the office using local anesthesia
No open incision and small incision closed without sutures
Less scarring and postoperative therapy typically not required
Less discomfort and most patients only require over-the-counter pain medications
Most cost-effective surgical strategy

What Does the Surgical Wound Look Like After a Percutaneous Release?

Trigger finger release at the 2-weeks post-operative follow-up visit after an open release versus a percutaneous release.

SEE THE DATA

Abdoli A, Hashemizadeh Aghda SM, Jalil Abrisham SM. Comparing the Corticosteroid Injection and A1 Pulley Percutaneous Release in Treatment of Trigger Finger: A Clinical Trial. J Hand Surg Asian Pac Vol. 2021 Jun;26(2):207-213. Read Article

Colberg RE, Pantuosco J, Fleisig G, Drogosz M. Ultrasound-Guided Microinvasive Trigger Finger Release Technique Combined With Three Tests to Confirm a Complete Release. Am J Phys Med Rehabil. 2020 Dec;99(12):1150-1156. Read Article

Gancarczyk SM, Jang ES, Swart EP, Makhni EC, Kadiyala RK. Percutaneous Trigger Finger Release: A Cost-effectiveness Analysis. J Am Acad Orthop Surg. 2016 Jul;24(7):475-82. Read Article

Guo D, McCool L, Senk A, Tonkin B, Guo J, Lytie RM, Guo D. Minimally invasive thread trigger digit release: a preliminary report on 34 digits of the adult hands. J Hand Surg Eur Vol. 2018 Nov;43(9):942-947. Read Article

Liu WC, Lu CK, Lin YC, Huang PJ, Lin GT, Fu YC. Outcomes of percutaneous trigger finger release with concurrent steroid injection. Kaohsiung J Med Sci. 2016 Dec;32(12):624-629. Read Article

Marij Z, Aurangzeb Q, Rizwan HR, Haroon R, Pervaiz MH. Outpatient Percutaneous Release of Trigger Finger: A Cost Effective and Safe Procedure. Malays Orthop J. 2017 Mar;11(1):52-56. Read Article

Nikolaou VS, Malahias MA, Kaseta MK, Sourlas I, Babis GC. Comparative clinical study of ultrasound-guided A1 pulley release vs open surgical intervention in the treatment of trigger finger. World J Orthop. 2017 Feb 18;8(2):163-169. Read Article

Siddiqui AA, Rajput IM, Adeel M. Outcome of Percutaneous Release for Trigger Digits in Diabetic and Non-diabetic Patients. Cureus. 2019 May 2;11(5):e4585. Read Article

Weiss ND, Richter MB. Percutaneous release of trigger digits. Am J of Orthopedics. 2017; 46(4):E263-E267. Read Article

White RZ, Sampson MJ. Assessment of short-term response and review of technique of ultrasound-guided percutaneous A1 pulley release for the treatment of trigger finger. J Med Imaging Radiat Oncol. 2021 Mar 21. Read Article

Yang TC, Fufa D, Huang HK, Huang YC, Chang MC, Wang JP. Percutaneous A1 Pulley Release Combined with Finger Splint for Trigger Finger with Proximal Interphalangeal Joint Flexion Contracture. J Hand Surg Asian Pac Vol. 2019 Sep;24(3):270-275. Read Article

Patient Testimonials

Kim D

East Bridgewater MA

I have seen Dr. Sussman for a chronic plantar fasciitis. I had seen several physicians regarding this condition and he was the only one who was able to cure it completely. He was understanding, patient and committed to finding a remedy and getting me back to working out and pain free. I couldn't be happier with him as an orthopedic physician.

Elliot Z

Stoughton MA

My experience is simple. I had four tears in my elbow. After Dr. Sussman’s performed PRP on me I was skeptical because it did not work for the first 3 weeks then the fourth week the pain level started to go down. I am now 100 percent better. I pay tennis on an A level and now I can even throw a baseball about 300 yard again.

Chanelle B

Portsmouth RI

Dr. Sussman is the first physician I've met during the last eight years of seeking an explanation and successful plan of treatment for my hip and sacroiliac pain. Each visit he has shown both his compassion for what I am going through. I trust Dr. Sussman completely. He takes my perspective as a patient into account, allowing us to work as a team towards a goal.

References:

Weiss ND, Richter MB. Percutaneous release of trigger digits. Am J of Orthopedics. 2017; 46(4):E263-E267.
Salim, N, Abdullah, S, Sapuan, J, Haflah, NH. Outcome of corticosteroid injection versus physiotherapy in the treatment of mild trigger fingers. J Hand Surg Eur. 2012, 37: 27–34
Bruijnzeel H, Neuhaus V, Fostvedt S, Jupiter JB, Mudgal CS, Ring DC: Adverse events of open A1 pulley release for idiopathic trigger finger. J Hand Surg Am 2012;37:1650-1656
Gulabi D, Cecen GS, Bekler HI, Saglam F, Tanju N: A study of 60 patients with percutaneous trigger finger releases: Clinical and ultrasonographic findings. J Hand Surg Eur Vol 2014;39:699-703
Guo D, McCool L, Senk A, Tonkin B, Guo J, Lytie RM, Guo D. Minimally invasive thread trigger digit release: a preliminary report on 34 digits of the adult hands. J Hand Surg Eur Vol. 2018 Nov;43(9):942-947.
Shen PC, Chou SH, Lu CC, Fu YC, Lu CK, Liu WC, Huang PJ, Tien YC, Shih CL. Comparative effectiveness of various treatment strategies for trigger finger by pairwise meta-analysis. Clin Rehabil. 2020 Sep;34(9):1217-1229

Ultrasound Guided Percutaneous Trigger Finger Release

How is this procedure performed?

An ultrasound guided percutaneous trigger finger release is different than a traditional percutaneous release. Ultrasound guidance allows the physician to visualize the thickened tendon and A1 pulley. The physician can direct a specially designed needle to the A1 pulley, cutting the pathologic tissue.
If done correctly, patients should not feel any residual catching/locking after the procedure and rate of recurrence is less than 1%.²

What are the risks of a percutaneous release compared to open surgery?

The risks of a percutaneous release are similar to complications of open surgery or cortisone injections.
Laceration of the tendon has been reported in 13% of cases treated with percutaneous release.4 Ultrasound minimizes the risk associated with a percutaneous release.

What does the Research Say?

Percutaneous A1 pulley release has been shown to be effective and safe.
Surgical treatments had the highest success rate among all treatments with a success rate of >90%. The analysis showed no significant difference between open surgery and a percutaneous minimally invasive trigger finger release.

Trigger Finger