Thread Trigger Finger Release

1. Numbing. Local anesthetic numbs the base of the finger. You stay awake. No IV, no sedation, no operating room.

2. Ultrasound finds the pulley. Ultrasound shows the A1 pulley, the tight band that catches the tendon, along with the tendon beneath it and the nerve and artery on either side of the finger. Every structure is identified before anything else happens.

3. Needle and thread. A thin needle passes beneath the A1 pulley, between the pulley and the tendon, staying clear of the nerve and artery. A smooth thread is fed through and looped around the pulley, with both ends exiting through the skin.

4. The pulley is divided. Drawing the ends of the thread back and forth divides the A1 pulley from the inside outward. The A2 pulley, the band that keeps the tendon tracking properly, is left intact.

5. Done. Two poke holes. The thread is removed. What remains are two needle puncture sites, covered with bandaids. No incision was made and there are no stitches to remove.

What is released. Only the A1 pulley, the specific band that causes triggering. It is the same structure that is divided in traditional open surgery.

What is protected. The A2 pulley stays intact, so the tendon keeps tracking normally against the bone. The digital nerve and artery, which run along each side of the finger close to the working area, are watched on ultrasound in real time throughout.

In the cadaveric studies of this technique, complete A1 release was achieved in every digit tested, without injury to the nerves, arteries, flexor tendon or the A2 pulley.

Open release is a well established operation with decades of results behind it, and Dr. Dashe performs it as well. Which approach fits your finger is a decision made together at your evaluation.

We think patients deserve the honest picture, so here it is.

The thread technique for trigger finger has been validated in cadaveric, or anatomy lab, studies. In the foundational study (Guo et al., 2017) the technique achieved complete release of the A1 pulley in every digit tested, with no injury to the nearby nerves, arteries, flexor tendon or the A2 pulley. Clinical outcome studies of the thread technique on fingers have not yet been published.

Percutaneous release as a class, the broader family of needle based techniques that release the A1 pulley without an incision, does have published clinical results. Those results describe percutaneous release generally, not the thread technique specifically.

Open surgical release remains the most studied option. Dr. Dashe performs injections, open release and thread release, and at your consultation he will lay out the evidence for each and tell you which he would recommend for your finger, and why.

Worth a consultation if a finger locks, catches, clicks or gets stuck when bending or straightening, especially if splinting or a cortisone injection has not settled it, and you would prefer to avoid an open incision and stitches.

Not offered for the thumb. Dr. Dashe performs thread release on the fingers. A trigger thumb is treated with the other options, including injection and open release.

May not be the right fit. Some fingers and some situations are better served by an injection or an open release, for example after prior surgery on the same finger. Dr. Dashe examines each finger with ultrasound and will tell you plainly which option he recommends, including when that option is not the thread.

1. Examination. Dr. Dashe examines your finger and confirms the diagnosis. Trigger finger is usually identified in the exam room, without special tests.

2. Ultrasound. An ultrasound look at the A1 pulley, tendon, nerve and artery, the same view used during a thread release.

3. An honest conversation. Every option on the table: watching and waiting, splinting, cortisone injection, open release, thread release. You leave with a recommendation and a plan.

Same or next day appointments are available. Call (510) 297-0550.

Thread Trigger Finger — what trigger finger is, why it happens, and every treatment option.

Injection or Surgery? — not sure whether to try a cortisone shot first? Start here.

Thread Carpal Tunnel Release — Dr. Dashe uses the same thread approach, the Guo Technique, for carpal tunnel syndrome.