Open versus percutaneous release for trigger digits: Reversal between short-term and long-term outcomes

Open trigger finger release is an elective surgical procedure that serves as the gold standard treatment for trigger digits. The aim of this procedure is to release the A1 pulley in a setting in which the pulley is completely visible, ultimately allowing the flexor tendons that were previously impinged on to glide more easily through the tendon sheath. Although A1-or the first annular pulley-is the site of triggering in nearly all cases, alternative sites include A2, A3, and the palmar aponeurosis1. Typically, the surgical procedure can be conducted in an outpatient setting and can vary in duration from a few minutes to half an hour. The surgical procedure involves the patient lying in the supine position with the operative hand positioned to the side. A small incision, ranging from 1 to 1.5 cm, is made on the volar side of the hand, just proximal to the A1 pulley in the skin crease in order to minimize scarring. Once the underlying neurovascular structures are exposed, the A1 pulley is released longitudinally at least to the level of the A2 pulley, followed by decompression of the flexor tendons that were previously impinged on. In order to confirm the release, the patient is asked to flex and extend the affected finger. The wound is irrigated and closed once the release is confirmed by both the patient and surgeon. Aside from an open release, trigger finger can be treated nonoperatively with use of splinting and corticosteroid injection. Alternative operative treatments include a percutaneous release, which involves the use of a needle to release the A1 pulley2. Trigger finger can initially be treated nonoperatively. If unsuccessful, surgical intervention is considered the ultimate remedy2. Because of their efficacious nature, corticosteroid injections are indicated preoperatively, particularly in non-diabetic patients3. Splinting is often an appropriate treatment option in patients who wish to avoid a corticosteroid injection1. However, if nonoperative treatment modalities fail to resolve pain and symptoms, surgical intervention is indicated2. In comparison with a percutaneous trigger finger release, an open release provides enhanced exposure and may be safer with respect to avoiding iatrogenic neurovascular injury2. However, in a randomized controlled trial, Gilberts et al. found no difference in the rates of recurrence when comparing open versus percutaneous trigger finger release4. With reported success rates ranging from 90% to 100%, the open release of the A1 pulley is considered a common procedure associated with minimal complications2. Complications of the procedure were assessed in a retrospective analysis of 43 patients who underwent 78 open trigger releases performed by 1 surgeon. In that study, the authors reported a minor complication rate of 28% and a major complication rate of 3%5. Specifically, the 2 major complications noted by the authors were a synovial fistula and a proximal interphalangeal joint arthrofibrosis. In a larger study that included 543 patients who underwent 795 open trigger releases, the authors reported a minor complication rate of 9.6% and major complication rate of 2.4%6. Furthermore, the most common complications involved persistent stiffness, swelling, or pain. In that analysis, the authors suggested that sedation, male gender, and general anesthesia may be associated with greater risk6. At the discretion of the surgeon, a longitudinal, transverse, or oblique incision is made directly on top of the tendon at the level of the metacarpophalangeal joint, which is the preferred incision site because it provides maximal accessibility to the A1 pulley.Local anesthesia is preferred because it allows the patient and surgeon to confirm the release immediately.If conducting an open trigger release on the thumb, the surgeon should identify and protect the radial digital nerve, which courses directly over the A1 pulley. MCP = metacarpophalangeal.

Introduction. Trigger finger is one of the most common causes of hand pain and disability. Surgical treatment consists of release of the A-1 pulley by open or percutaneous techniques. Many authors have noted that percutaneous release is convenient and cost-effective with a low complication rate. Only few studies have published results on combination of percutaneous release and steroid injection.
 Objective. To compare the differences of outcomes in adults with trigger finger treated with combination of percutaneous release and corticosteroid injection to those treated with percutaneous release alone
 Methods. We included all patients older than 18 years old in the UP-PGH Department of Orthopedics with a diagnosis of trigger finger who have consented to participate in this study. They were randomized into two treatment groups. One group was treated with percutaneous release only and the other group was treated with combined percutaneous release and corticosteroid injection. Outcomes measured were total active motion (TAM), postoperative pain, time to return-to-work, patient satisfaction, and complications.
 Results. Post-procedure, both groups showed significant improvement in motion of the fingers (p = 0.034) and pain relief (p = 0.001). TAM scores of the combination group were better compared to the control at all time intervals (p = 0.03, 0.008, 0.004, 0.019) and better pain VAS scores in the 1st week (p = 0.009). Patients who received the combination treatment showed a trend toward better patient satisfaction, shorter duration of post-release pain and earlier return-to-work.
 Conclusion. The addition of corticosteroid injections to percutaneous release of trigger finger significantly improves TAM and pain VAS scores.

IntroductionTrigger finger is a common cause of pain and disability of the hand. Percutaneous release results in earlier functional recovery and patient satisfaction. This is a rapid and cost-effective method which saves a surgical procedure and results in better functional outcome.Materials and MethodsThis is a prospective observational study conducted on fifty-two fingers and thumbs in 52 patients treated from 1st July 2014 till 31st December 2014, in the Orthopaedic Section, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan. All the baseline characteristics of the patients, like demographics, symptoms, Quinell's criteria and functional outcome were recorded. The patients were treated at our hospital with trigger finger, managed with percutaneous release using an 18 gauge needle and followed up for a minimum period of three months. The follow-up information included range of motion scoring, patient satisfaction and overall outcome of the procedure in terms of patient acceptance. The data was analyzed to determine the functional outcome at three months.ResultsThere was complete release of A1 pulleys in 52 out of 52 digits (100%) in the patients undergoing percutaneous release and significant patient satisfaction. No recurrence was observed.ConclusionPercutaneous release of trigger finger with needle was not only associated with excellent functional outcome and recovery in terms of patient satisfaction and range of finger motion three months post-procedure but also was found to be cost effective.

ObjectivesPediatric trigger thumb (PTT) is characterized by flexion deformity and interphalangeal joint locking caused by A1 pulley constriction. Open A1 pulley release is the standard surgical method, whereas percutaneous release under local anesthesia offers a minimally invasive outpatient alternative. This study compared the outcomes of these two techniques.MethodsA retrospective cohort of children aged 2–10 years undergoing A1 pulley release between 2012 and 2024 was analyzed. Patients were assigned to open release under general anesthesia or percutaneous release under local anesthesia. Demographics, operative details, complications, and outcomes were compared using appropriate statistical tests, with significance set at p<0.05.ResultsNinety-nine patients (107 thumbs) were included: 53 (58 thumbs) in the open group and 46 (49 thumbs) in the percutaneous group. Mean age at surgery was similar (4.33 ± 1.53 vs. 4.29 ± 1.70 years; p=0.781). Satisfactory results were achieved in 100 % of open and 85.7 % of percutaneous cases (p=0.003). Recurrence was 3.4 % and 8.2 %, respectively (p=0.409). No neurovascular or tendon injuries occurred; superficial infections were minor and limited to the open group.ConclusionsBoth techniques are effective and safe. Open release remains the gold standard, while percutaneous release is a practical minimally invasive option in selected patients.Level of evidenceIII, retrospective comparative study.

Introduction: Tennis Elbow is a familiar term used to describe myriad of symptoms around the lateral aspect of the elbow. It occurs more frequently in non-athletes than athletes. Tennis elbow has a reported prevalence of 2% in the general population. It is most commonly seen in patients between the ages of 30 and 50 years. Tennis Elbow is considered resistant if it fails to respond to conservative means of treatment for at least six months.Methods: Patients meeting the criteria were divided randomly into two groups of open surgical release and percutaneous release using random number generator software and respective surgery was done. Functional score, time to return to pre-injury status and patient satisfaction were noted at two months and six months follow up.Results: Among 62 patients (34 female, 28 male) enrolled, 32 patients (mean age 42.5 years) were allocated to open group and 30 patients (mean age 44.2 years) were allocated to percutaneous group. At two months follow up, 81% of open group had excellent to good score and 19% of cases had fair score as compared to 90% cases of percutaneous group with excellent to good score and 10%with fair score (p = 0.376). At six months follow up, both open and percutaneous group had 90% excellent to good results and 10% fair results (p = 0.596). The mean time to return to work of open release was 6.03 weeks and percutaneous release was 2.3 weeks (p = 0.0001).Conclusions: Percutaneous release and open surgical release in surgical management of resistant tennis elbow have statistically similar functional outcome. The time to return to work after percutaneous release is significantly earlier.

Outcome of percutaneous trigger finger release technique using a 20-gauge hypodermic needle

Management of Diabetic Trigger Finger

Ultrasound-guided trigger finger release with a minimally invasive knife: A retrospective analysis of 297 releases.

Percutaneous Release of Trigger Fingers

A prospective randomized trial for release of the first annular pulley (A-1 pulley) in trigger fingers with a percutaneous technique versus the open surgical technique is presented. Thirty-six patients were randomized to either open (n = 16) or percutaneous (#15 blade; n = 20) release of the A-1 pulley. All patients were evaluated for grip strength, active range of motion of the proximal interphalangeal joint, and residual pain at 1 and 12 weeks after release. Furthermore, the operation time was assessed, and the costs were calculated. Overall, 100% success in terms of grip strength, active range of motion of the proximal interphalangeal joint, and residual pain was obtained in both groups. Mean operation time was significantly longer with the open technique. Because of lower costs and quicker procedure with equal functional outcome when compared with open surgery, we recommend the percutaneous technique using a #15 blade for trigger finger release.

BackgroundAlthough percutaneous trigger digit release is common, controversy exists regarding its safety. The purpose of this study was to evaluate the feasibility and safety of the neurovascular displacement by local hydraulic dilatation (LHD) during percutaneous trigger digit release.Material/MethodsTen cadaver hands with 50 digits were dissected in this anatomical study. The distance between bilateral neurovascular bundles in each digit was measured before LHD and after LHD. The difference between the measured data before LHD and those after LHD in the same digit was compared to assess the feasibility of the neurovascular displacement by LHD. A further 81 patients with 106 trigger digits were treated by percutaneous release with neurovascular displacement by LHD in our clinical series. All patients were followed for 12 months. During the follow-up period, the presence of any postoperative complication and patient satisfaction were recorded.ResultsIn our anatomical study, there was a statistically significant difference (p<0.05) comparing the average distance of bilateral neurovascular bundles before LHD with that after LHD. In the current series, no complications, such as digital neurovascular injury or recurrence of trigger, were encountered. On subjective assessment, 80/81 patients (98.8%) with 105/106 digits (99.1%) were graded as satisfactory with complete resolution of symptoms by percutaneous release under LHD.ConclusionsBased on our study anatomical and clinical results, the neurovascular displacement by LHD may be a feasible adjunctive technique that may play a role in increasing the safety of percutaneous trigger digit release.

This study aims to compare the postoperative clinical outcomes of open A1 pulley release with and without flexor tendon traction tenolysis. Outcomes assessed include finger range of motion, hand function (Disabilities of the Arm, Shoulder, and Hand [QuickDASH] score), complications (eg, digital nerve injury, superficial infection, and residual trigger finger), and surgery duration. A prospective study was conducted from January 2018 to June 2019, involving patients with grade II-III trigger finger requiring surgical intervention. Patients were randomized into two groups: group I (open A1 pulley release with flexor tendon traction tenolysis) and group II (open A1 pulley release without flexor tendon traction tenolysis). Postoperative assessments were conducted at 2 weeks, 2 months, and 4 months, documenting finger range of motion, QuickDASH scores, complications, and surgery duration. A total of 50 patients met the selection criteria, with 46 completing the study. The majority were women, with an average age of 56 ± 9.6 years. The patients were predominantly diabetic with the condition affecting the left hand and middle finger and presenting as grade III trigger finger. Baseline characteristics, including age, gender (female/male), ethnicity, occupational status, diabetes status, and trigger finger severity, were comparable between the two groups. Preoperative QuickDASH scores were also similar. The mean preoperative finger range of motion at the metacarpophalangeal and proximal interphalangeal joint were lower in group I but were not statistically important. Patients in group I exhibited consistently better postoperative finger range of motion and QuickDASH scores compared to group II throughout the follow-up period. The difference was statistically important at the 2-week follow-up. Although group I continued to show better outcomes at 2 and 4 months, the differences were not statistically important. Surgery duration was importantly longer in group I (16.4 ± 5.7 minutes) compared to group II (11.43 ± 3.8 minutes). Two patients in group I experienced wound infections, which resolved with a week-long course of antibiotics. Open A1 pulley release with flexor tendon traction tenolysis resulted in better early postoperative (2 weeks) finger flexion range of motion and QuickDASH scores, albeit with a longer surgery duration. Therapeutic Ib.

Background: trigger thumbs in children predominantly present with flexion deformity and a nodule at the MCP joint. Surgical release with a transverse incision and splitting of the A1 pulley achieves good cosmoses and attains a satisfactory range of motion with minimal complications. Aim of the Work: to analyze the results of treatment of congenital trigger thumb by open surgical release. Patients and Methods: this study was carried out on 12 patients with congenital trigger thumb treated by surgical release of A1 pulley after obtaining the hospital’s Research Ethics Committee approval and written informed consents from the patients. Results: twelve patients were followed up for a mean of 10 (range 4–16) weeks, by which time they were all free of pain and had normal strength subjectively. Of the 12 patients evaluated postoperatively, all were able to fully extend the interphalangeal joint of the involved thumb. Conclusion: Surgical management is the most common treatment, and this is done effectively and safely in the hands of experienced surgeons with pediatric anesthesiologists.

Background: Trigger finger (stenosing tenosynovitis) is a common condition characterized by painful locking or snapping of the affected digit due to thickening of the A1 pulley and flexor tendon inflammation. Surgical release of the A1 pulley is considered the gold standard for cases refractory to conservative management. This study evaluates clinical outcomes following open surgical release of the A1 pulley in 36 patients. Material and Methods: A prospective observational study was conducted on 36 patients diagnosed with trigger finger and treated with open A1 pulley release between January 2023 and December 2025 at Government Medical College Rajouri. Patients were evaluated using Quinnell grading, Visual Analogue Scale (VAS) for pain, and range of motion (ROM) preoperatively and during follow-up at 2 weeks, 6 weeks, and 3 months postoperatively. Results: The mean age was 47.8 ± 10.4 years, with female predominance (61%). The thumb was the most commonly involved digit (44%), followed by the ring finger (28%). Complete resolution of triggering was achieved in 94.4% of patients. Mean VAS score improved significantly from 6.8 ± 1.1 preoperatively to 0.9 ± 0.6 at 3 months (p &lt; 0.001). Minor complications were observed in 2 patients (5.5%), including superficial wound infection and transient stiffness. No recurrence was observed during follow-up. Conclusion: Open surgical release of the A1 pulley is a safe, effective, and definitive treatment for trigger finger, demonstrating high success rates and minimal complications in the present study. Keywords: Trigger finger, Stenosing tenosynovitis, A1 pulley release, Hand surgery, Surgical outcomes.

Office-Based Open Trigger Finger Release Has a Low Complication Rate