A, Percutaneous release of long finger A1 pulley. Metacarpophalangeal joint hyperextended and 19-gauge needle inserted just distal to flexor crease. Bevel of needle oriented longitudinally with tendon. Skin markings indicate path of flexor tendons. B, Needle stabilized and pulley released from proximal to distal. Loss of grating sensation as pulley is cut indicates completion of release SEE TECHNIQUE 76.2.