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Feb 12, 2023

Journal Watch: Cadaveric Study Demonstrates that the Percutaneous Trigger Finger Release as Effective as Open Release, but with Several Advantages


Identification and division of the A1 pulley through a palmar incision is the traditional operative treatment for trigger finger after failing conservative treatment. Various alternative techniques using specially designed or custom-made instruments or needles have been reported as an alternative to the traditional open release.

The percutaneous release approach has significantly better rehabilitation results than the open surgical techniques (Gilberts et al, 2001), but historically there has been concern that the percutaneous release has inherent risk not associated with the open release, including injury to adjacent structures such as the neurovascular bundle or tendon.

Study Results

This cadaveric study, tested whether ultrasound visualization would allow direct visualization of the A1 pulley and adjacent structures in addition to real-time guidance during the release. Chern et al (2005) performed ultrasound guided A1 pulley releases on 10 cadavers. In this study, there was a complete release in 48 of the 50 digits released (96 percent). In the partial releases, less than 2mm of the A1 pulley remained. There was no significant flexor tendon injury or laceration of the tendon. In 3 of the digits (6 percent), there was mild surface scratches noted. There was no digital nerve injury in any digit or significant injury to the A1 pulley.

In this study, Chern et al also performed 28 trigger finger releases in 20 patients and inn all cases there was complete relief of triggering symptoms with no complications noted and no recurrence.


This study demonstrated that percutaneous release of trigger digits can be effective in releasing the A1 pulley and is comparable to the release achieve by a traditional open release, but with several advantage:

  • Can be performed under local anesthesia without a tourniquet
  • Takes less time
  • Produces less postoperative pain
  • Requires less recovery time
  • Allows patients to return to work sooner
  • Precludes the possibility of a painful palmar scar
  • Significantly less expensive

In clinical review, whether using a needle or other cutting devices the claimed rates of success were between 73.8 and 100% with the percutaneous release (Lorthioir, 1959; Tanaka et al, 1990; Eastwood et al, 1992; Lyu, 1992; Pope & Wolfe, 1995; Patel & Moradia, 1997; Cihantimur et al, 1998; Ha et a, 2001; Blumberg et al, 2001; Gilberts et al, 2001). The success of a percutaneous release in other cadaveric studies using similar techniques has not been as successful (Dunn & Pess, 1999; Bain et a, 1995; Pope & Wolfe, 1995). The authors found that using ultrasound guidance improves the rate of complete releases in this cadaveric study. Pecutaneous releases techniques using vague and subjective landmarks of skin creases and performed blind without guidance may account for the complications associated with unguided percutaneous techniques according to Chern et al, and in the present report ultrasound assisted percutaneous release of the A1 pulley produces minimal risks.


  1. Bain GI, Turnbull J, Charles MN, Roth JH, Richards RS. Percutaneous A1 pulley release: a cadaveric study. J Hand Surg Am. 1995 Sep;20(5):781-4;discussion 785-6.
  2. Blumberg N, Arbel R, Dekel S. Percutaneous release of trigger digits. J Hand Surg Br. 2001 Jun;26(3):256-7.
  3. Chern TC, Jou IM, Yen SH, Lai KA, Shao CJ. Cadaveric study of
    sonographically assisted percutaneous release of the A1 pulley. Plast Reconstr Surg. 2005 Mar;115(3):811-22.
  4. Cihantimur B, Akin S, Ozcan M. Percutaneous treatment of trigger finger. 34 fingers followed 0.5-2 years. Acta Orthop Scand. 1998
  5. Dunn MJ, Pess GM. Percutaneous trigger finger release: a comparison of a new push knife and a 19-gauge needle in a cadaveric model. J Hand Surg Am. 1999 Jul;24(4):860-5.
  6. Eastwood DM, Gupta KJ, Johnson DP. Percutaneous release of the trigger finger: an office procedure. J Hand Surg Am. 1992 Jan;17(1):114-7.
  7. Gilberts EC, Beekman WH, Stevens HJ, Wereldsma JC. Prospective
    randomized trial of open versus percutaneous surgery for trigger digits. J Hand Surg Am. 2001 May;26(3):497-500.
  8. Ha KI, Park MJ, Ha CW. Percutaneous release of trigger digits. J Bone Joint Surg Br. 2001 Jan;83(1):75-7.
  9. LORTHIOIR J Jr. Surgical treatment of trigger-finger by a subcutaneous method. J Bone Joint Surg Am. 1958 Jul;40-A(4):793-5.
  10. Lyu SR. Closed division of the flexor tendon sheath for trigger finger. J Bone Joint Surg Br. 1992 May;74(3):418-20.
  11. Patel MR, Moradia VJ. Percutaneous release of trigger digit with and without cortisone injection. J Hand Surg Am. 1997 Jan;22(1):150-5.
  12. Pope DF, Wolfe SW. Safety and efficacy of percutaneous trigger finger release. J Hand Surg Am. 1995 Mar;20(2):280-3.
  13. Tanaka J, Muraji M, Negoro H, Yamashita H, Nakano T, Nakano K.
    Subcutaneous release of trigger thumb and fingers in 210 fingers. J Hand Surg Br. 1990 Nov;15(4):463-5.

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