Ultrasound-Guided Percutaneous Versus Open A1 Pulley Release for Trigger Finger: A Randomized Controlled Trial

Background/Objectives: Trigger finger is a common cause of hand pain and functional limitation. Although open A1 pulley release remains the standard surgical treatment, ultrasound-guided percutaneous needle release (UGPR) has emerged as a minimally invasive alternative. This study aimed to compare the clinical effectiveness and safety of UGPR with open surgery. Methods: In this prospective, randomized controlled trial, 146 patients with Green stage 2-4 trigger finger were randomly assigned to UGPR (n = 75) or open release (n = 71). Pain (VAS), functional status (QuickDASH), and symptom severity (Nirschl Phase Rating) were assessed preoperatively and at postoperative day 3, 1, 6, and 12 months. Grip strength was measured with a digital pinchmeter, and ultrasonographic evaluation of A1 pulley and flexor tendon thickness was performed preoperatively and at 12 months. Subgroup analyses were conducted to address the imbalance in thumb distribution. Results: Both groups showed significant postoperative improvements in VAS, QuickDASH, and Nirschl scores (p < 0.05 for intragroup comparisons), with no significant differences between groups at 12 months (p > 0.05). At the one-year follow-up, grip strength was significantly greater in the UGPR group (p = 0.008). Ultrasonographic evaluation revealed greater MCP tendon thickness in UGPR, without clinical impact. Subgroup analyses confirmed comparable functional outcomes in thumb-only and non-thumb cases. Four revisions occurred in the UGPR group (incomplete release, recurrent tenosynovitis, flexor tendon rupture, and neurovascular injury), while none were observed in the open group. Conclusions: UGPR and open release provide comparable long-term outcomes in the treatment of trigger finger. UGPR offers the advantages of being minimally invasive and preserving grip strength, although it carries a small risk of incomplete release and procedure-related complications. Patient preference, surgeon expertise, and digit type should guide treatment selection.