Objective <p>To retrospectively evaluate outcomes of an ultrasound-guided A1 pulley fenestration release technique using small-gauge (hypodermic or spinal) needles for the treatment of trigger finger (TF).</p> Materials and methods <p>A retrospective chart review of all TF fenestration release procedures performed by two musculoskeletal radiologists between July 2020 and August 2024 was conducted. The technique included a steroid injection after release. Preprocedural and postprocedural functional Quinnell grades and any immediate complications from the procedure report were primary outcome measures. Clinical pain score, functional outcomes, other TF interventions, and delayed complications were secondary outcome measures.</p> Results <p>A total of 119 procedures were performed in 92 patients (61% women, mean age 63 ± 13&#xa0;years), with 95 procedures (80%) following prior TF injection with refractory symptoms. Periprocedural Quinnell grades were reported in 99 procedures (83%), with immediately improved scores for all (median-preprocedural-to-postprocedural, 3-to-0; <i>p</i> &lt; 0.001). Retrospective follow-up data were available for 60 procedures (50%), of which 70% experienced functional improvement. Pain scores were significantly improved at follow-up (median-preprocedural-to-follow-up, 4-to-0.5; <i>p</i> = 0.046). Subsequent interventions occurred following 22 cases (18%), of which 15 (13%) required additional steroid injections, 3 (3%) required repeat fenestration, and 5 (4%) required surgical release. No immediate or delayed complications were otherwise reported. Higher Quinnell grade at end of procedure predicted increased rates of follow-up (OR = 3.17, p = 0.012) and suggested worse functional status at follow-up (OR = 0.25, <i>p</i> = 0.054), and smaller peri-procedural improvement increased odds of additional intervention (OR = 0.48, p &lt; 0.001).</p> Conclusion <p>Ultrasound-guided fenestration is an effective and safe treatment for TF in the outpatient setting.</p>