Trigger finger

Trigger finger, or stenosing flexor tenosynovitis, is a catching, clicking or locking of a finger or thumb as it bends and straightens. It happens because the tendon that bends the finger no longer glides freely through the A1 pulley, a ring of tissue at the base of the finger that holds the tendon against the bone. The needling research falls into two groups. Most of the trials below test acupotomy, also called needle-knife or miniscalpel-needle therapy, in which a needle with a flat blade about 1 mm wide at its tip is used to cut the A1 pulley through the skin, often under ultrasound. Its reviewers describe it as working like percutaneous A1 pulley release, which hand surgeons perform with a needle or small blade, and the trials compare it mostly with surgery, steroid injection or acupotomy done without ultrasound. A smaller group tests needling without a blade: acupuncture or dry needling at the pulley itself.

What Cochrane reviews found for standard treatments

Cochrane has no review of acupuncture or acupotomy for trigger finger. Its three reviews of the condition cover the treatments the needling trials are compared with.

• Steroid injection, 2009. Peters-Veluthamaningal and colleagues, searching to November 2007, found two small randomised trials with 63 participants, both of poor methodological quality. A corticosteroid injected with the local anaesthetic lidocaine succeeded more often at four weeks than lidocaine alone (relative risk 3.15, 95% CI 1.34 to 7.40), and in one trial the effect lasted up to four months. No adverse events were reported.
• Surgery, 2018. Fiorini and colleagues, searching to August 2017, included 14 trials with 1,260 participants, most of them at high or unclear risk of bias. Five compared percutaneous release with steroid injection and five compared percutaneous with open surgery. Against steroid injection, low-quality evidence from two trials (270 participants) found triggering returned in fewer people after open surgery over six to 12 months (risk ratio 0.17), at the cost of more palm pain in the first week. The review was uncertain whether surgery resolved more cases, and no trial reported hand function or satisfaction.
• Anti-inflammatory injection, 2021. Leow and colleagues found two trials with 231 participants comparing a single low-dose injection of diclofenac or ketorolac with a steroid injection. At low to very low certainty, the drug injection offered little to no benefit over the steroid by 24 weeks.

A 2026 network meta-analysis by Chiang and colleagues, which compares treatments directly and through common comparators, pooled 27 randomised trials with 2,099 participants and 12 treatments, searched to July 2025. Percutaneous release had the highest probability of treatment success and higher odds of success than steroid injection (odds ratio 22.82, 95% CI 7.69 to 67.72). Its abstract does not name acupotomy or acupuncture among the 12 treatments.

Systematic reviews of acupotomy

At Kyung Hee University in Seoul, Kwon, Yoon and Lee reviewed the systematic reviews of acupotomy published to February 2019. The reviews reported higher total effective and cure rates with acupotomy than with active controls for trigger finger, frozen shoulder, knee osteoarthritis and three spinal conditions, and the overview concluded that more high-quality evidence was needed before acupotomy could be recommended.

Li and colleagues at Jiangxi University of Chinese Medicine searched Chinese and English databases for trials of acupotomy for tenosynovitis of the hand flexor tendons. They reported a higher effective rate (odds ratio 6.77), a higher cure rate (odds ratio 3.32) and pain 1.21 points lower on a 10-point visual analogue scale with acupotomy. They rated every trial at high risk of bias because neither patients nor practitioners were blinded, and no trial reported blinding the people who measured the outcomes. The effective and cure rates are grades the investigators assigned against a Chinese medical efficacy standard. The authors called for higher-quality trials.

Liang and colleagues at Guangzhou University of Chinese Medicine restricted their review to acupotomy under ultrasound. All 15 trials were Chinese, published between 2016 and January 2023. Against the pooled controls, acupotomy under ultrasound had a higher clinical effectiveness rate (odds ratio 4.83, 95% CI 2.49 to 9.37), pain 1 point lower on a 10-point scale, a lower Quinnell grade (a 0 to 4 scale of triggering severity), fewer complications (four trials) and fewer recurrences (two trials). The pooled pain and Quinnell results carried heterogeneity of 99%, meaning the trials disagreed with one another far more than chance allows, and Egger's test found evidence of publication bias. The review pooled ultrasound-guided acupotomy against blind acupotomy, open surgery and steroid injection in a single estimate, which the authors list as a limitation. Its table of included trials gives two of them, of 74 and 60 people, identical baseline ages and disease durations.

A 2024 meta-analysis by Rohilla, Kaur and Tiwari compared ultrasound-guided with blind percutaneous pulley release in general, not acupotomy alone. Residual triggering was less common with ultrasound (risk ratio 0.16, 95% CI 0.03 to 0.87), and the difference in complications was not significant.

Trials

Acupotomy against steroid injection or surgery

• Against steroid injection, 2009. At Sun Yat-sen University in Guangzhou, Chao, Wu and Yan randomised 93 trigger thumbs in 83 people to percutaneous release with a miniscalpel-needle or a steroid injection. At 12 months 44 of 46 thumbs in the release group had a satisfactory result against 12 of 47 after injection. No digital nerve was injured in either group.
• Against open surgery, 2023. At Nanchang University, Lan and colleagues randomised 72 people with grade 2 or worse trigger digits to open release (30) or ultrasound-guided release with a modified small needle-knife (42). Pain and Quinnell grade fell in both groups at 7 and 30 days, and the groups did not differ at 7, 30 or 180 days.
• The thumb, three ways, 2024. In Luliang, Shanxi, Li and colleagues randomised 60 people with trigger thumb to ultrasound-guided needle-knife release, conservative treatment or open surgery, 20 each, with blinded assessors. Through three months the needle-knife group had lower Quinnell grades and pain than the conservative group and did not differ from the surgery group. Complications followed 5% of needle-knife releases, 10% of conservative treatments and 15% of operations.
• Added to injection, 2019. Zhang, Yao and Wu gave 74 people an ultrasound-guided injection into the tendon sheath, with or without needle-knife release at the tender point. Scores on the authors' own 9-point scale were lower with the needle-knife immediately and at one and three months.

Needling without a blade

• Dry needling against no treatment, 2019. At Tehran University of Medical Sciences, Azizian and colleagues randomised 58 people aged 45 to 75, without diabetes, to a single minute of dry needling into the A1 pulley or no intervention. A blinded assessor measured them once, a week later. Pain on a 10-point scale fell from 4.4 to 1.8 with needling and from 3.8 to 3.6 without, and disability scores, pinch grip and ultrasound thickness of the pulley also favoured needling. There was no sham group and no follow-up beyond one week.
• Acupuncture at the pulley, 2016. At Meiji University of Integrative Medicine in Kyoto, Inoue and colleagues needled either side of the flexor tendon at the A1 pulley in 19 fingers of 15 people, daily for up to five sessions. Pain and the severity of snapping improved from the second treatment, more so in people who had had the condition for a shorter time. The study had no control group.

Dry needling describes how the method differs from acupuncture, and Sham acupuncture sets out what an inactive control would add that none of these trials had.

Harms

The trials above report few complications, and their numbers are small. A 2021 case report by Liew and Teh, orthopaedic and hand surgeons at Universiti Putra Malaysia and Sunway Medical Centre, described a rupture of flexor pollicis longus, the tendon that bends the tip of the thumb, after acupuncture for trigger thumb. A 2024 letter from Kim, Kim and Kang at Kyung Hee University summarises the case: a 48-year-old woman had three painful sessions of acupuncture at two points along the palm side of the thumb two months earlier. The letter argues that the report did not rule out other causes, such as earlier steroid injections, inflammatory arthritis or diabetes, and that some flexor pollicis longus ruptures are spontaneous. Liang and colleagues note that acupotomy without ultrasound is a closed procedure guided by the operator’s feel, in which tendons, blood vessels and nerves can be injured, and give that as the reason for adding ultrasound.

What guidelines say

AcuiQ found no clinical guideline for trigger finger that addresses acupuncture, acupotomy or dry needling. A 2023 primary care review in the Singapore Medical Journal, by Ng, Sirisena and Chua, which is a teaching article rather than a guideline, sets out the usual sequence: education, splinting and pain relief first, then steroid injection and surgical release. It does not mention acupuncture. Clinical guidelines compares how guideline bodies treat acupuncture across conditions.

What the reviews could not settle

The acupotomy trials test a percutaneous release of the A1 pulley, an operation hand surgeons already perform with other instruments, so they compare ways of cutting the pulley rather than testing needling at acupuncture points. The two meta-analyses of them pooled unblinded Chinese trials against different controls in single estimates, measured success mostly by an efficacy grade the investigators assigned, and found evidence of publication bias; neither graded its certainty. For needling without a blade there is one trial against no treatment with a week of follow-up and one uncontrolled case series, and none of the trials found for this page compared either with sham needling or with steroid injection. The carpal tunnel syndrome and tennis elbow pages report the needling trials for two other conditions of the hand and arm.

AcuiQ’s trigger finger page lists the protocols individual studies prescribed, each with its citation.