Pulley Release Research Articles

Percutaneous ultrasound-guided A1 pulley release utilizing a modified 20-gauge spinal needle.

Trigger finger is a common cause of hand pain. Though multiple techniques for percutaneous A1 pulley release have been described in the literature, there is a continued need for safe and effective techniques using inexpensive, familiar, and commonly found instruments. This study evaluated outcomes of percutaneous A1 pulley release performed using a novel technique with a modified 20-gauge spinal needle and ultrasound guidance, with follow-up outcomes at least 6 months after the procedure. To evaluate the efficacy and safety of a novel percutaneous A1-pulley release technique in individuals with trigger finger. Retrospective observational study. Private practice outpatient orthopedics clinic. Forty digits from 30 unique patients with trigger finger who underwent percutaneous A1 pulley release. Percutaneous ultrasound-guided A1 pulley release performed with a modified 20-gauge spinal needle. The primary outcome measure was cessation of triggering. Secondary measures examined intraoperative and postoperative pain, postprocedural duration of activity limiting pain, and time to perform the procedure. Immediate cessation of triggering was achieved in all 40 digits following the procedure, with no recurrence reported at any time at an average follow-up of 11 months (range 6-32). Patients reported returning to normal activity in 2.75 days. Only one minor complication was reported, tenosynovitis, which resolved with a corticosteroid injection. Percutaneous, ultrasound-guided A1 pulley release performed with a modified 20-gauge spinal needle can be safely performed with good outcomes and a rapid return to normal activity.

A1 Pulley Reconstruction for Severe Trigger Finger.

The aim of this study was to evaluate the effectiveness of A1 pulley reconstruction in treating severe trigger fingers and to compare its outcomes with those of the traditional A1 pulley release technique. A total of 43 patients participated in the study, divided into two groups: 22 patients underwent A1 pulley reconstruction, while the remaining 21 patients received the standard A1 pulley release procedure. The outcomes were assessed using the Michigan Hand Outcomes Questionnaire (MHQ) 1 month post-surgery. The results demonstrated that patients who received the A1 pulley reconstruction reported significantly better outcomes. These included enhanced hand function and quality of life, reduced levels of pain, improved aesthetic appearances, and higher overall satisfaction when compared to the traditional release group. The findings suggest that A1 pulley reconstruction offers superior benefits over the standard release procedure for individuals suffering from severe trigger fingers, highlighting its potential as a more effective surgical intervention.

Retrospective Evaluation of Patients Who Received Surgery as the First Option in the Treatment of Green Type 3-4 Trigger Finger

AİM: To evaluate the clinical and functional outcomes of the patients with trigger finger patients who are treated by open surgery method without applying conservative treatment modalities METHODS: Open A1 pulley surgical release under local anesthesia was applied to 67 trigger finger patients ( 45 female, 22 male, mean age 53,82, range 11-81). The mean follow-up was 38,37 months (range 4-76 months). As assosiated pathologies, there were type 2 DM in 14 and chronic renal failure in 1 patients. RESULTS: In 67 patients pain and triggering were found to be treated by open surgical A1 pulley release. No recurrence seen in triggering nodularity. Postoperatively there were no significant neurovascular complications noted CONCLUSION: As similar to literature, we believe that in the treatment of trigger finger with open surgery method is a safe and effective method and also supplies fast return to daily life. We think that the surgery may be the first choice in selected cases.

Risk Factors for Requiring Ulnar Superficialis Slip Resection During Trigger Finger Release

Ulnar superficialis slip resection (USSR) has been described to address persistent postoperative triggering following trigger finger release (TFR). The primary purpose of our study was to evaluate the results of simultaneous TFR and USSR under wide-awake local anesthesia no tourniquet (WALANT). The secondary purpose was to identify patient characteristics and risk factors associated with persistent triggering following A1 pulley release requiring USSR. We retrospectively identified 1,005 patients who underwent TFR at one institution by a single fellowship-trained, hand surgeon under WALANT from 2015 to 2023. Nine hundred ninety-two patients were treated with TFR alone. Twelve patients (1.2%) underwent USSR because of persistent triggering that was identified in the operating room after release of the A1 pulley. An age-, sex-, and body mass index-matched cohort of 28 patients who underwent TFR alone was created. Medical records were reviewed for demographics and complications. A total of 12 patients (14 digits) underwent TFR with USSR. The long finger was the most commonly affected finger (6, 42%). Patients in the USSR group had more average lifetime trigger fingers compared with the control group (4 vs 1). Additionally, the percentage of patients who had previously undergone TFRs for other fingers was higher in the USSR group (100%) compared with the control group (36%). After surgery, 6 patients (4 USSR and 2 control) underwent formal hand therapy for postoperative stiffness with USSR patients receiving therapy more often than controls. Although uncommon, some patients (1.2%) who undergo TFR require USSR for persistent triggering following A1 pulley release. Patients who have had more lifetime trigger fingers and/or who have previously undergone TFR for other fingers are more likely to need USSR. No serious complications were incurred by patients who underwent USSR, but these patients may benefit from hand therapy compared to those undergoing isolated TFR. Therapeutic III.

Paediatric trigger thumbs: patient-reported outcome measures over a minimum of ten years' follow-up.

The paediatric trigger thumb is a distinct clinical entity with unique anatomical abnormalities. The aim of this study was to present the long-term outcomes of A1 pulley release in idiopathic paediatric trigger thumbs based on established patient-reported outcome measures. This study was a cross-sectional, questionnaire-based study conducted at a tertiary care orthopaedic centre. All cases of idiopathic paediatric trigger thumbs which underwent A1 pulley release between 2004 and 2011 and had a minimum follow-up period of ten years were included in the study. The abbreviated version of the Disabilities of Arm, Shoulder and Hand questionnaire (QuickDASH) was administered as an online survey, and ipsi- and contralateral thumb motion was assessed. A total of 67 patients completed the survey, of whom 63 (94%) had full interphalangeal joint extension or hyperextension. Severe metacarpophalangeal joint hyperextension (> 40°) was documented in 15 cases (22%). The median QuickDASH score was 0 (0 to 61), indicating excellent function at a median follow-up of 15 years (10 to 19). Overall satisfaction was high, with 56 patients (84%) reporting the maximal satisfaction score of 5. Among 37 patients who underwent surgery at age ≤ two years, 34 (92%) reported the largest satisfaction, whereas this was the case for 22 of 30 patients (73%) with surgery at aged > two years (p = 0.053). Notta's nodule resolved in 49 patients (73%) at final follow-up. No residual triggering or revision surgery was observed. Surgical release of A1 pulley in paediatric trigger thumb is an acceptable procedure with excellent functional long-term outcomes. There was a trend towards higher satisfaction with earlier surgery among the patients.

Effects of A2 Pulley Venting on Bowstringing and Tendon Slack: A Biomechanical Investigation.

A2 pulley release is often needed for exposure of the lacerated tendon, retrieval of retracted tendons, placement of core sutures, or to permit full motion and gliding of the repaired and edematous tendon. However, there is no agreement in the literature on the specific quantity of pulley venting that can be performed and recommendations are limited to an undefined "judicious release" of the pulleys when necessary. Following a previously developed testing protocols, finger kinematics, tendon excursion, and bowstringing were evaluated on cadaveric hands for venting in increments of 20% of the pulley length. In our study, we found a statistically significant influence of venting on bowstringing, although no difference was found between fingers, and a significant difference in tendon slack, which was variable depending on the finger. Bowstringing started increasing at 20% of A2 venting and peaked at full release. Tendon slack did not start until 40% of A2 venting on the index finger, but started at 20% on the middle, ring, and small fingers. Venting of the A2 pulley leads to an incremental increase in tendon bowstringing and tendon slack. However, differences in metacarpophalangeal flexion angle were not observed until full A2 pulley release, and only observed in the index finger, and no differences were observed in proximal interphalangeal flexion angles. Therefore, the benefit of releasing the A2 pulley when clinically necessary will likely outweigh the risks of loss of motion or strength.

Percutaneous Surgery for Trigger Finger Treatment Using a Novel Surgical Device: An Experimental Study on Fresh Cadavers

Trigger finger, a stenosing tenosynovitis of the flexor tendon at the A1 pulley, can cause pain and impair daily activities. Despite common surgical interventions, postsurgical complications are frequent, prompting the search for less invasive techniques. An experimental study was conducted on fresh cadavers to compare three techniques: the first using a PulleyCut without ultrasound guidance, the second using a PulleyCut with ultrasound guidance, and the third using a percutaneous needle technique. The complete release of the A1 pulley, integrity of the A2 pulley, flexor tendons, and neurovascular bundles were assessed. The new device group and the ultrasound-guided group demonstrated 100% complete release of the A1 pulley, whereas the needle group achieved only 38% success. There were no A2 pulley injuries in any group. Flexor tendons were injured in 7% of cases in the new device group and 77% in the needle group. A neurovascular injury occurred in the needle group. Compared with the percutaneous needle technique, the new device proved safe and effective for A1 pulley release, minimizing damage to flexor tendons and neurovascular structures. Ultrasound did not provide significant advantages, suggesting that the new device can be confidently used without ultrasound assistance. The PulleyCut represents a promising percutaneous technique for trigger finger treatment, demonstrating superiority over the needle technique in terms of efficacy and safety. These results encourage future clinical investigations to validate its practical application. Therapeutic IIc.

Open Versus Percutaneous Fixation of Trigger Finger: Meta-Analysis of Clinical Outcomes

With variable and conflicting results to date, it remains unclear whether the percutaneous or open surgical A1 pulley release technique is superior regarding safety and efficacy. The goal of this meta-analysis was to compare the two techniques. PubMed, Cochrane, and Google Scholar (pages 1-20) were searched through August 2023. Eight randomized controlled trials met the inclusion criteria and were included in this meta-analysis. Of the eight included studies and 548 total patients, there were 278 subjects in the percutaneous release group and 270 subjects in the open release group. There was no significant difference between the two surgical techniques in postoperative rates of revision, complications, or pain. This meta-analysis found no significant difference between open and percutaneous techniques regarding the need for revision procedures, complications, or postoperative pain. Therefore, both open and percutaneous releases are appropriate. Therapeutic I.

Early Formation of a Tenosynovial Retinacular Cyst Between A1 and A2 Pulleys After Open A1 Pulley Release

Case: A 66-year-old woman presented with a left middle trigger finger and underwent a proximal annular pulley (A1) release. Four weeks later, she presented with a new mass in the same finger without recurrent triggering. She was found to have a tenosynovial retinacular cyst, which was surgically excised. Conclusion: This case demonstrates early ganglion cyst formation between A1 and A2 pulleys after A1 pulley release. Although the etiology is unclear, this case illustrates effective treatment strategies.

A Review of 1228 In-Office Hand Surgery Procedures With Wide Awake Local Anesthesia No Tourniquet (WALANT) at a Single Private Practice.

This study examined the complication rate of Wide Awake Local Anesthesia No Tourniquet (WALANT) technique in the clinic setting with field sterility at a single private practice. We hypothesized that WALANT is safe and effective with a low complication rate. This retrospective chart review included 1228 patients who underwent in-office WALANT hand procedures at a single private practice between 2015 and 2022. Patients were divided into groups based on type of procedure: carpal tunnel release, A1 pulley release, first dorsal compartment release, extensor tendon repair, mass excision, foreign body removal, and needle aponeurotomy. Patient demographics and complications were recorded; statistical comparisons of cohort demographics and risk factors for complications were completed, and P < .05 was considered significant for all statistical comparisons. The overall complication rate for all procedures was 2.77% for 1228 patients including A1 pulley release (n = 962, 2.7%), mass excision (n = 137, 3.7%), extensor tendon repair (n = 23, 4.3%), and first dorsal compartment release (n = 22, 8.3%). Carpal tunnel release, foreign body removal, and needle aponeurotomy groups experienced no complications. No adverse events (e.g. vasovagal reactions, digital ischemia, local anesthetic toxicity, inadequate vasoconstriction) were observed in any group. Patients with known autoimmune disorders and those who were currently smoking had a statistically significant higher complication rate. Office-based WALANT procedures with field sterility are safe and effective for treating common hand maladies and have a similar complication profile when compared to historical controls from the standard operating room in an ambulatory center or hospital.

A Comparison of Patient Characteristics and Outcomes Between Patients Receiving Flexor Digitorum Superficialis Slip Excision or Isolated A1 Pulley Release for Trigger Finger

Resection of the radial or ulnar slip of the flexor digitorum superficialis (FDS) tendon is a known treatment option for persistent trigger finger. Risk factors for undergoing FDS slip excision are unclear. We hypothesized that patients who underwent A1 pulley release with FDS slip excision secondary to persistent triggering would have a higher comorbidity burden compared to those receiving A1 pulley release alone. We identified all adult patients who underwent A1 pulley release with FDS slip excision because of persistent triggering either intraoperatively or postoperatively from 2018 to 2023. We selected a 3:1 age- and sex-matched control group who underwent isolated A1 pulley release. Charts were retrospectively reviewed for demographics, selected comorbidities, trigger finger history, and postoperative course. We performed multivariable logistic regression to assess the probability of FDS slip excision after adjusting for several variables that were significant in bivariate comparisons. We identified 48 patients who underwent A1 pulley release with FDS slip excision and 144 controls. Our multivariable model showed that patients with additional trigger fingers and a preoperative proximal interphalangeal (PIP) joint contracture were significantly more likely to undergo FDS slip excision. Patients who underwent A1 pulley release with FDS slip excision were significantly more likely to have multiple trigger fingers or a preoperative PIP joint contracture. Clinicians should counsel patients with these risk factors regarding the potential for FDS slip excision in addition to A1 pulley release to alleviate triggering of the affected digit. Therapeutic III.

Surgery for Pediatric Trigger Finger.

Pediatric trigger finger (PTF) is an uncommon condition that is 10 times less common than trigger thumb. The Quinnell grade is utilized to quantify the extent of the triggering on a 4-point scale (0 = normal movement, 1 = uneven movement, 2 = actively correctable triggering, 3 = passively correctable triggering, and 4 = fixed deformity)1. Less extensive triggering can be treated nonoperatively with use of monitoring or splinting; however, the reported resolution rates are low, with only 30% of PTF cases treated nonoperatively achieving complete resolution1. Splinting has also been shown to not improve resolution rates in pediatric cases treated nonoperatively. In contrast, operative intervention has a high likelihood of restoring motion and function of the affected digit2,3. Overall, PTF has been shown to have significantly higher rates of resolution when treated operatively (97.1%) versus nonoperatively (30.0%)2. PTF may be safely and predictably treated with use of operative release of the A1 pulley and resection of a single flexor digitorum superficialis (FDS) tendon slip. PTF treated with this technique predictably results in resolution with restoration of motion. The present video article demonstrates the surgical treatment of a 7-year-old with a locked right ring finger. Operative steps include (1) general anesthesia, (2) tourniquet control, (3) loupe magnification, (4) neurovascular identification, (5) A3 and A1 pulley release, (6) excision of the ulnar slip of the FDS, (7) and simple closure. The primary alternative to this procedure is nonoperative treatment with continued monitoring and/or splinting. PTF differs from pediatric trigger thumb. Simple release of the A1 pulley may not resolve the triggering, requiring additional excision of the ulnar slip of the FDS. Jia et al. reported that only 30% of nonoperatively treated cases of PTF achieved complete resolution, and splinting did not improve resolution rates3. In contrast, operative intervention has a high likelihood of restoring motion and function of the affected digit. Overall, operatively treated PTF showed significantly higher rates of complete resolution compared with nonoperatively treated PTF (97.1% compared with 30.0%, respectively)3. Additionally, Cardon et al. reported residual triggering in 44% (8) of 18 cases of PTF treated with isolated A1 pulley release2. Bae et al. reported a 91% success rate (21 of 23) when PTFs were treated uniformly with A1 pulley release combined with FDS slip excision1. We conclude that PTF may be safely and predictably treated with use of operative release of the A1 pulley and resection of a single FDS tendon slip. General anesthesia will limit inadvertent patient movement for a safer surgery.Identify neurovascular bundles to prevent inadvertent injury.Utilize loupe magnification to aid in identification of neurovascular bundles.Perform a Bruner incision for wide exposure and excision of the ulnar FDS. FDP = flexor digitorum profundusFDS = flexor digitorum superficialisDIP = distal interphalangeal joint.

Serious Complications of the Percutaneous A1 Pulley Release: Case Reports and Literature Review.

Percutaneous first annular pulley (A1 pulley) release, which has been increasingly used to treat trigger fingers, has been widely established as a safe and simple procedure. Multiple studies have reported positive results of percutaneous A1 pulley release. In this study, however, we report cases of patients who developed complications after undergoing percutaneous A1 pulley release at local clinics. A total of six patients visited our hospital for infectious complications after percutaneous A1 pulley release. Various sequelae such as damage to normal structures, insufficient procedure, and tissue necrosis were observed during the exploration. A retrospective study was conducted to identify the cause and trend of the observed complications by instruments (HAKI knife or needle). In the HAKI knife group, there was a tendency for damage to normal structures, while in the needle group, an insufficient release or serious soft tissue necrosis was observed. Based on these cases, our findings confirm the existence and characteristics of infectious complications following the percutaneous A1 pulley release. We further identify that the type of instrument used predicts the nature of complications. Thus, reliable and skilled performance of the procedure by experts is essential for safe treatment.

Prospective Randomized Controlled Trial Comparing Absorbable and Nonabsorbable Sutures in A1 Pulley Release.

Both absorbable and nonabsorbable sutures are used to correct palmar incisions or lacerations. Nonabsorbable sutures have been used without complications but require removal at a follow-up appointment. Alternatively, the use of absorbable sutures has increased in popularity as postoperative suture removal is not required but is associated with local immunological and inflammatory responses. In this study, we compared the scar quality and outcomes of nonabsorbable and absorbable sutures in A1 pulley release. Patients who underwent A1 pulley release were randomized to 1 of 2 suture materials. The Patient Scar Assessment Scale, Observer Scar Assessment Scale, Visual Analogue Scale, and Disabilities of the Arm, Shoulder, and Hand scores were collected at 2, 6, and 12 weeks postoperatively. Among the 41 patients included in the study, 23 were randomized to the nonabsorbable suture group, and 18 to the absorbable suture group. There were no significant differences between the two suture groups in the aforementioned assessments. Complication rates were higher in the nonabsorbable suture group, but the difference was not statistically significant. Notably, 1 case in the absorbable suture group had uncontrolled postoperative bleeding and required reoperation. We found no significant difference between the two materials in terms of the Patient or Observer Scar Assessment Scales, overall complication rates, symptom scores, or pain scores. Therefore, the choice using absorbable or nonabsorbable can be guided by other factors such as physician or patient preference, availability, and cost.

Sonographically controlled minimally-invasive A1 pulley release using a new guide instrument – a case series of 106 procedures in 64 patients

BackgroundWith percutaneous and minimally-invasive pulley release becoming more popular, safety and reliability of such minimally-invasive procedures remain a concern. Visualization of the technical steps by ultrasound suggests increased safety but shows the potential for harm to tendons, nerves and vessels without proper instrumentation. We present the results of implementing a sonographically guided minimally-invasive procedure in 106 trigger digits of 64 patients between 2018–2021.MethodsA guide instrument for use with a commercially available hook knife was developed and tested in 16 cadaver hands. Due to complication early in our clinical series this guide was modified in due course. A revised design of the guide has been in use since November 2019 with improved performance and safety.ResultsOne hundred six procedures in 64 patients were performed. After guide revision, we report a success rate of 97.3%. Complications after instrument revision include two cases of incomplete pulley release and one case of inadvertent skin laceration. The majority of patients report returning to all strenuous activities within two weeks at most apart from four individuals with prolonged postoperative discomfort.ConclusionWe present the results of the development and implementation of a novel guide instrument for use with a hook knife to treat trigger finger. Despite several limitations of this study, we show that sonographically controlled, minimally-invasive A1 pulley release can be performed safely and effectively with appropriate surgical instruments and practice.

Changes in flexor pollicis longus tendon cross-sectional dimensions after A1 pulley release for paediatric trigger thumb.

In this study, 30 patients with unilateral paediatric trigger thumb were examined with measurements taken within 1 month before surgery, and at 3 months after surgery. We measured the dorsal-palmar (DP) diameter, radioulnar (RU) diameter and cross-sectional area (CSA) of the flexor pollicis longus (FPL) tendon at two sites: just proximal to the A1 pulley and underneath the A1 pulley using ultrasonography. Following surgical A1 pulley release, the DP diameter, RU diameter and CSA of the FPL tendon just proximal to the A1 pulley significantly decreased from 2.6 mm to 2.2 mm, from 5.1 mm to 4.2 mm and from 11 mm2 to 7.8 mm2, respectively. Additionally, the RU diameter and CSA of the FPL tendon at the area beneath the A1 pulley significantly increased from 2.2 mm to 3.2 mm and from 4.3 mm2 to 5.8 mm2, respectively. This finding suggests that the conformation of the FPL tendon of the affected thumb tends to return to that of the contralateral uninvolved thumb after A1 pulley release. Underdevelopment of the inner space around the A1 pulley may contribute to the development of paediatric trigger thumb.Level of evidence: III.

Comparison of Percutaneous A1 Pulley Release versus Steroid Injection in Terms of Mean Pain Score in Trigger Digits

Objective: To compare percutaneous A1 pulley release and steroid injection in terms of mean pain score in trigger digit. Study Design: Comparative cross- sectional study. Place and Duration of Study: Orthopedic Department Combined Military Hospital, Rawalpindi Pakistan, from Mar to Aug 2018. Methodology: Patients with trigger finger diagnosed clinically in Out Patient Department meeting inclusion and exclusion criteria were included in the study. Patients were randomly allocated to Group A &amp; B by lottery method. Group A had percutaneous release of A1 pulley using a surgical blade 11, after preparation of the skin and injection of 1ml 2% plain Lidocaine. Group B had injection with corticosteroid. Both procedures were carried out in Out Patient Department under strict aseptic measures. Visual analogue score at start and end of the study was recorded. Results: A total of 185 patients were included in this study, 122(66%) were males and females were 63(34%). The mean age of patient was 37.80±11.80 years with range from 15-60 years. Mean score of Group A was 39.16±12.22 years and the mean age Group B was 38.93±10.98 years. 56(30.3%) patient had mild visual analogue score, 96 (51.9%) had moderate visual analogue, 33(17.8%) had severe visual analogue. Conclusion: Percutaneous release was found better option for the treatment of the trigger digit with a high success rate. Surgery should be reserved only for cases refractory to steroid injection technique.

Not Just Another Trigger Finger.

Open A1 pulley release for trigger finger has generally been considered a minor procedure with infrequent complications. Most reported complications are minor, including scar pain and tenderness, mild extension lag, and recurrence of triggering. Rates of major complications, such as bowstringing, neurovascular bundle injury, and infection requiring reoperation, are less than 1% to 4%. We aimed to describe the potentially devastating sequelae of these major complications and the subsequent consequences. Three patients underwent open trigger finger release, which were all complicated by severe postoperative surgical site infection requiring multiple subsequent procedures. We review our initial management, subsequent reconstructive options, and outcomes with up to 19 years follow-up. All 3 adult patients who underwent open A1 pulley release for trigger finger developed a surgical site infection, leading to flexor tenosynovitis requiring urgent operative debridement and multiple subsequent procedures. Two patients were poorly controlled diabetics, and the third patient was otherwise healthy. Each patient ultimately developed distinct consequences from their postoperative course-finger stiffness and contracture, disabling bowstringing requiring the use of a pulley ring, and flexor tendon rupture requiring staged tendon reconstruction, respectively. All 3 patients at final follow-up had a permanent functional deficit. Major complications after trigger finger release are infrequent. However, if left untreated, particularly in diabetic patients, there can be disastrous consequences, resulting in permanent loss of function. This case series highlights the importance of accurate diagnosis of postoperative infections and expedient treatment thereafter.

Ultrasound-Guided A1 Pulley Release: A Systematic Review.

The purpose of this review was to summarize the current literature pertaining to ultrasound-guided percutaneous A1 pulley release procedures. We searched PubMed, Cochrane Library, Embase, and Web of Science for clinical studies examining ultrasound-guided percutaneous A1 pulley release. A total of 17 studies involving 749 procedures were included in this review. The overall success rate was 97%. There were 23 minor complications (4 cases of hematomas, 15 cases of persistent pain, and 4 cases of transient numbness) and no major complications reported. Ultrasound-guided A1 pulley release is an effective and safe procedure for the treatment of trigger fingers and thumb.

Ultrasound-Guided Percutaneous Release of Pulley in Trigger Finger: A Curved Needle Technique

Thickened A1 pulley is the most common cause of trigger finger. The patient complains of snapping and locking of finger like a trigger as the gliding of the flexor tendon become harder through the thickened pulley during flexion and superadded development of nodule on the surface of the tendon proximal to pulley. In severe cases or failed conservative/steroid injection cases, real-time percutaneous release of pulley under ultrasound (US) guidance can be considered. The percutaneous pulley release is a minimally invasive procedure compared to open surgical release and more accurate than blind percutaneous release with overall minimal complications. The US-guided percutaneous A1 pulley release has been described in the literature and done by knife, straight needles, and acutely bent needles with variable results. We describe the curved needle technique of percutaneous pulley release. The curved needle technique for US-guided A1 pulley release is novel and has the advantage of easy maneuverability over acutely bent needle and minimal chances of complications. The cutting edge of the curved needle scores through the thickened pulley with effective release and easy maneuverability.