Worsening CTS following decompression

Hi there,

I am a 37M MSK Physio (no PMHx) and had a right sided endoscopic decompression surgery on the 28/9/24 to my right hand. Symptoms prior to surgery were numbness and tingling in the median nerve distribution in the hand and progressive weakness. Prior to surgery, NCS showed mild compression and neck MRI ruled out nerve root Involvement. I also had a CSI around 18 months prior which failed to settle symptoms.

I’m now under a new surgeon who requested new NCS and a wrist MRI. NCS came back as mild and if anything slightly improved. The MRI showed inflammation at the entrance of the tunnel. In addition, a colleague at work performed an ultrasound which showed that the median nerve was thickened throughout 14-16mm diameter though moves well through the tunnel.

The surgeon recommended a steroid injection to my right wrist, which I had last Thursday. Unfortunately this has failed to help and if anything has slightly worsened the numbness. I do appreciate sometimes the steroid can take a little while to kick in. He has also asked me to lay off lifting weights (was doing this x3 a week), which I’ve been adhering too but would be interested to hear if this is something you’d advocate for too while my problem persists.

He has suggested that should the injection fail, we go down the road of decompression surgery. However, I am feeling a little sceptical about this because he made no mention of incomplete release of the carpal ligament from the MRI (though this is an assumption). I am obviously ignorant here and so am wondering if further decompression seems like a reasonable course of action? Would other techniques I’ve heard about such as using a hypothenar fat pad or a versa sleeve around the median nerve potentially be more suitable here?

Sorry for the lengthy message.

Thanks in advance for any advice,
Chris