Objective: To evaluate the causal association between serum albumin and carpal tunnel syndrome (CTS) and to investigate the mediating role of leptin in this relationship. Methods: In April 2025, data on serum albumin, leptin (adjusted for body mass index), and CTS from Genome-Wide Association Studies (GWAS) and FinnGen public databases were collected for a two-way, two-sample Mendelian randomization (MR) analysis. Causal analyses were performed using inverse variance weighted (IVW), weighted median estimator, MR-Egger, simple mode, and weighted mode methods. The robustness of the results was tested using Cochran's Q statistic, MR-Egger intercept test, Mendelian randomization pleiotropy residual sum and outlier (MR-PRESSO) test. A two-step approach was used to analyze the mediating effect of leptin between serum albumin and CTS. Results: The IVW analysis showed that elevated serum albumin levels significantly increased the risk of CTS (OR=1.18, 95%CI: 1.00-1.38, P=0.045), and the results from the weighted median estimator and weighted mode method were consistent with the IVW direction and the differences were statistically significant (P<0.05). Mediation analysis revealed a significant negative causal effect between serum albumin and leptin (OR=0.44, 95%CI: 0.28-0.68, P<0.001), and elevated leptin levels significantly reduced the risk of CTS (OR=0.79, 95%CI: 0.68-0.94, P=0.006). Leptin played a key mediating role in the path of serum albumin affecting CTS (β(indirect)=0.190, P=0.027), with a mediation proportion of 118%. Reverse MR analysis showed that the causal effect of CTS on serum albumin was not statistically significant (OR=1.00, 95% CI: 0.97-1.04, P=0.889). There were no statistically significant differences in the heterogeneity test (Cochran's Q=20.68, P=0.079) and multi-effect test (MR-Egger intercept value -0.004, P=0.684; MR-PRESSO global P=0.067) . Conclusion: There is a positive causal relationship between serum albumin level and the risk of CTS, and leptin level plays an important mediating role in this pathway, suggesting that albumin may indirectly increase the risk of CTS through the modulation of leptin, and provide new genetic clues for the identification of people at high risk of CTS.

BACKGROUND Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, causing pain, numbness, and functional limitations. Home-based treatments have recently been receiving increasing attention. Kinesio taping (KT) and transcutaneous electrical nerve stimulation (TENS) are non-invasive physical therapy interventions. This study aimed to compare treatment outcomes from 6 weeks of home-based KT and TENS combined with myofascial stretching in adults with CTS. MATERIAL AND METHODS A single-blind randomized controlled trial was conducted. Of 42 CTS participants, 30 completed the study (12 of the 42 were lost to follow-up) and were randomized to home-based KT (n = 15) or TENS (n = 15). Both groups received 6 weeks of physical interventions combined with self-applied myofascial stretching, followed by a 6-week follow-up, Outcomes were evaluated using the grip and pinch strengths, the Boston Carpal Tunnel Questionnaire (BCTQ), the visual analog scale (VAS), the Modified Moberg Pick-up Test (MMPUT), and 2-point discrimination (2PD). RESULTS Both groups had significant improvement in VAS, BCTQ, grip, and pinch strengths, 2PD, and MMPUT (P = 0.014, P < 0.001). Group × time interactions indicated that improvements over time differed between groups, with KT producing slightly greater gains in grip strength (P = 0.005), pain (P = 0.033), symptom severity (P < 0.001), and dexterity (P = 0.002) compared with TENS. CONCLUSIONS KT and TENS treatment both improved hand function and dexterity, decreased symptom severity and pain, with KT showing slightly greater benefits in grip strength, dexterity, symptom severity, and pain.

The sciatic nerve is the largest nerve in the human body and is frequently affected by lesions, causing pain and even loss of sensitivity. The sciatic nerve injury model provides a robust platform to study the degeneration-regeneration process. In this context, Schwann cells (SC) are central regulators of peripheral nervous system (PNS) development, homeostasis, and regeneration. During development, SC arise from neural crest-derived precursors and undergo tightly regulated lineage progression, culminating in myelinating and non-myelinating phenotypes. This process is orchestrated by coordinated transcriptional, signaling, and epigenetic mechanisms that control radial sorting, differentiation, and myelination. Following nerve injury, SC exhibit remarkable plasticity, reprogramming into a specialized repair phenotype that promotes axonal regeneration through debris clearance, trophic support, immune modulation, and the formation of Büngner bands. This work aims to summarize the known history of the plasticity and functions of SC during nerve development and regeneration. It also aims to highlight the most recent advances regarding the molecular networks underlying SC plasticity, as well as epigenetic regulators that enable dynamic transitions between cellular states. This work also describes the factors compromising nerve regeneration and functional recovery, and summarizes the emerging therapeutic strategies aimed to overcome these limitations by enhancing SC plasticity, modulating the injury microenvironment, and developing alternative cell sources, including stem cell-derived Schwann-like cells. A deeper understanding of SC heterogeneity, lineage dynamics, and regenerative mechanisms will be essential for advancing translational strategies. Collectively, this review underscores the pivotal role of SC in nerve regeneration and highlights innovative approaches to harness their therapeutic potential.

Carpal tunnel syndrome (CTS) may represent an early manifestation of systemic amyloidosis. Musculoskeletal manifestations such as CTS, trigger finger, or Dupuytren's disease may precede cardiac or neurological symptoms by many years, thereby opening a potentially relevant diagnostic window.We conducted a retrospective-prospective analysis of all carpal tunnel release procedures performed at our center between 2013 and 2025. For the period from 2013 to 2023, demographic data and information on tissue excision and histological examination were collected. For 2024, an additional retrospective histological re-examination of available specimens was performed using Congo red staining and polarization microscopy. Beginning in May 2025, biopsies from trigger finger release and partial aponeurectomy for Dupuytren's disease were also prospectively examined. In addition, a narrative literature review on the clinical relevance of musculoskeletal manifestations in amyloidosis was conducted.Among 990 carpal tunnel releases, tissue samples were obtained in 32.4% (n=321), and 25.2% (n=81) were histologically examined. Amyloid deposits were detected in 18.8% (n=15) of the samples. The median age of amyloid-positive patients was 82 years; men were more frequently affected (73%; OR 4.6; p=0.001). Musculoskeletal red-flag conditions were strongly associated with amyloid detection (RR 6.0; p<0.001). Cardiac comorbidities were present in 37.5% of amyloid-positive patients, including two with confirmed cardiac amyloidosis. Five patients showed neither cardiac nor neurological symptoms. In biopsies obtained during trigger finger release (since May 2025), amyloid deposits were identified in 15.4%, while no deposits were found in partial aponeurectomies for Dupuytren's disease.Our results support the observation that amyloid deposits can be detected during hand surgery procedures. Targeted histopathological examination of synovial tissue samples obtained during carpal tunnel or A1 pulley release procedures may serve as a valuable tool for the early detection of systemic amyloidosis. Given the high number of undiagnosed cases and the prognostic relevance, the integration of a risk-adapted biopsy strategy into existing guidelines should be considered.

Carpal tunnel syndrome (CTS), the most prevalent entrapment neuropathy of the upper extremities, presents diagnostic challenges due to nonspecific clinical symptoms and discrepancies between subjective experiences and objective findings. Traditional reliance on electrodiagnostic studies (EDX), including nerve conduction studies (NCS) and electromyography, as the traditional reference method for assessing median nerve function is limited by invasiveness, operator dependency, and reduced sensitivity in mild cases. Neuromuscular ultrasound (NMUS) has emerged as a non-invasive complementary imaging method, enabling visualization of morphological changes such as increased median nerve cross-sectional area (CSA) and restricted gliding. This narrative review synthesizes evidence on the diagnostic utility of NMUS and EDX. We found that while EDX remains the reference standard for functional grading (eg, distal motor latency), it is limited by its invasiveness. Conversely, NMUS excels in identifying anatomical pathologies (eg, CSA ≥10 mm²) but is operator dependent. Rather than using a single tool, we demonstrate that combining EDX's physiological precision with NMUS's anatomical visualization offers the highest diagnostic accuracy. Recent trends favor artificial intelligence (AI) integration and standardized multimodal protocols to bridge the current implementation gaps.

Carpal tunnel syndrome (CTS), a median nerve compression disorder, offers a model of chronic afferent deprivation, yet its systems-level impact on intrinsic brain networks remains unclear. We tested a tri-network hypothesis that dysregulated interactions among the salience (SN), sensorimotor (SMN), and default mode (DMN) networks underlie persistent functional impairment in CTS. Resting-state fMRI data were acquired from 52 CTS patients and 30 matched healthy controls. We examined static and dynamic functional connectivity among SN, SMN, and DMN, directional effective connectivity using network-level models, and a state-resolved cross-network interaction index quantifying the relative engagement of SN with SMN versus DMN. CTS patients showed reduced static SMN-DMN coupling and enhanced SMN-SN coupling, and effective connectivity analyses revealed diminished excitatory influence from SMN to SN. Dynamic analyses identified four recurrent connectivity states, with CTS patients spending more time in a state marked by strong SN-SMN coupling and DMN suppression. The cross-network interaction index consistently demonstrated a shift toward preferential SN-SMN engagement across dynamic states. Together, these findings indicate a reproducible pattern of SN-centered reorganization in CTS, characterized by strengthened SN-SMN coupling and diminished integration with the DMN. This tri-network profile suggests that chronic afferent deprivation leads to dysregulated salience-mediated allocation of attentional and sensorimotor resources, contributing to persistent functional impairment, and that such large-scale network alterations may serve as mechanistic markers for patient stratification and potential therapeutic modulation.