Eighty-four patients with grade III trigger finger were randomized to receive a classic open A1 pulley release (n=42) or a minimally-invasive, ultrasound-guided A1 pulley release (n=42). The primary outcome of interest was the Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) score. Additional outcomes of interest included the time to last analgesic use, time to complete digit flexion and extension, time to return to normal activities, and grip strength. Outcomes were assessed up to 1 year post-operation. The ultrasound-guided release led to significantly better QuickDASH scores in the first 3 months post-operation and better grip strength in the first week post-operation vs. classic open surgery. Moreover, the time to last analgesic use, time to complete digit flexion and extension, and time to return to normal activities were all significantly shorter in the ultrasound-guided group.