Abstract:   Introduction:   Trigger fingers can be treated by open or percutaneous division of the A1 pulley. The open approach allows for visualization of the pulley, as well as of the adjacent neurovascular bundles. The proponents of this technique argue that it allows a safer release of the trigger finger and ensures complete division of the A1 pulley. Many authors have advocated in favor of the percutaneous needle division, citing the lack of an incision as its biggest advantage. According to these reports, the percutaneous approach is safe and effective.   Ultrasound imaging has been reported as an adjunct for guiding the needle during percutaneous trigger finger release, and advocates of this technique have reported good clinical outcomes with what they feel is increased safety.   Materials and Methods:   This study was designed to evaluate the safety and efficacy of needle trigger finger release with added ultrasound imaging. 18 cadaver A1 pulleys were divided percutaneously and then evaluated by converting to an open technique and examining the hands for completeness of the division and possible underlying tendon injury. The ultrasound was used to identify the position of the needle tip during the procedure.      Results:   The ultrasound images demonstrated repeated puncture of the tendon sheath and of the neurovascular bundle during percutaneous division. The subsequent dissection revealed 3/18 tendons with visible lacerations and 15/18 A1 pulleys with incomplete division as evidenced by persistence of transverse fibers across the area of the pulley.   Conclusions:   Percutaneous trigger finger division can be associated with puncturing of the flexor tendon and adjacent neurovascular bundles, as demonstrated by our ultrasound images. Additionally, it may lead to incomplete division of the A1 pulleys as seen on our cadaver dissections. While the clinical significance of these findings is unclear to us, it does raise skepticism towards the safety of percutaneous trigger finger release in our hands.