Muscle biopsy

This procedure is usually done while you are awake. The health care provider will apply a numbing medicine (local anesthesia) to the biopsy area.

There are two types of muscle biopsy:

• A needle biopsy involves inserting a needle into the muscle. When the needle is removed, a small piece of tissue remains in the needle. More than one needle stick may be needed to get a large enough sample.
• An open biopsy involves making a small cut in the skin and into the muscle. The muscle tissue is then removed.

After either type of biopsy, the tissue is sent to a laboratory for examination.

No special preparation is usually needed. If you will have anesthesia, follow instructions on not eating or drinking anything before the test.

During the biopsy, there is usually little or no discomfort. You may feel some pressure or tugging.

The anesthetic may burn or sting when injected (before the area becomes numb). After the anesthetic wears off, the area may be sore for about a week.

A muscle biopsy is done to find out why you are weak when the doctor suspects you have a muscle problem.

A muscle biopsy may be done to help identify or detect:

• Inflammatory diseases of muscle (such as polymyositis or dermatomyositis)
• Diseases of the connective tissue and blood vessels (such as polyarteritis nodosa)
• Infections that affect the muscles (such as trichinosis or toxoplasmosis)
• Inherited muscle disorders such as muscular dystrophy or congenital myopathy
• Metabolic defects of the muscle
• Effects of medicines, toxins, or electrolyte disorders

A muscle biopsy may also be done to tell the difference between nerve and muscle disorders.

A muscle that has recently been injured, such as by an EMG needle, or is affected by a pre-existing condition, such as nerve compression, should not be selected for a biopsy.

A normal result means the muscle is normal.

A muscle biopsy can help diagnose the following conditions:

• Loss of muscle mass (atrophy)
• Muscle disease that involves inflammation and a skin rash (dermatomyositis)
• Inherited muscle disorder (Duchenne muscular dystrophy)
• Inflammation of the muscle
• Various muscular dystrophies
• Destruction of the muscle (myopathic changes)
• Tissue death of the muscle (necrosis)
• Disorders that involve inflammation of the blood vessels and affect muscles (necrotizing vasculitis)
• Traumatic muscle damage
• Paralyzed muscles
• Inflammatory disease causing muscle weakness, swelling tenderness, and tissue damage (dermatomyositis or polymyositis)
• Nerve problems that affect the muscles
• Muscle tissue under the skin (fascia) becomes swollen, inflamed, and thick (eosinophilic fasciitis)

There are additional conditions under which the test may be performed.

The risks of this test are small, but may include:

• Bleeding
• Bruising
• Damage to the muscle tissue or other tissues in the area (very rare)
• Infection (a slight risk any time the skin is broken)

Biopsy - muscle

Shepich JR. Muscle biopsy. In: Fowler GC, ed. Pfenninger and Fowler's Procedures for Primary Care. 4th ed. Philadelphia, PA: Elsevier; 2020:chap 188.

Warner WC, Sawyer JR. Neuromuscular disorders. In: Azar FM, Beaty JH, eds. Campbell's Operative Orthopaedics. 14th ed. Philadelphia, PA: Elsevier; 2021:chap 35.

Updated by: Diane M. Horowitz, MD, Rheumatology and Internal Medicine, Northwell Health, Great Neck, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.