Five randomized controlled trials including 275 patients with 283 trigger digits were included in this systematic review and meta-analysis comparing ultrasound-guided tendon release vs. open surgical release. Pooled outcomes of interest included Quick Disability of Arm, Shoulder, and Hand (QDASH) scores, grip strength, Visual Analogue Scale (VAS) scores, days to return to normal activities, and days to stopping analgesia. The pooled results showed that ultrasound-guided release significantly improved QDASH scores within the first month and reduced the days required to return to normal activities. There were no significant differences in grip strength, VAS scores, full-digit flexion, and extension between the two groups. The findings suggest that ultrasound-guided release offers a minimally invasive alternative with quicker functional recovery compared to open surgery.