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Trigger thumbs are classified on a scale type 1-4, where 1 is pain no clicking, 2 is clicking, 3 is locking requiring passive extension, and 4 is locked in position. The initial general recommendation is treatment with local corticosteroid injection. General reported success rate for injections is about 57% in the literature. We studied two cohorts of patients all with locked trigger thumbs (type 4) who were either treated with local corticosteroid injection (N=40) or percutaneous trigger release under local anesthesia in the office with a sterile 18 gauge needle (N=43). The patients treated with corticosteroid injection were followed for an average of 6.1 months and had a success rate of 59%. In this group 6 patients did not follow up (15%), 6 patients (15%) received a second injection and 2 received a percutaneous release (5%). In the percutaneous release group the average follow up time was 11.4 months, 4 patients did not follow up (9%), and the followed up patients had a success rate of 100%.