Can neuromuscular neurologists perform nerve/muscle biopsies?

[Neuroelectrobuzz]

Not just read the slides, but actually perform the procedure? If so, is it standard training in most fellowships?

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[Telamir]

Yes.

Not typically sural nerves or something like that (those bigger nerve biopsies tend to mess up the nerve) but small nerve biopsies (really just a skin punch biopsy) and muscle biopsies, sure.

 

[JBM16BYU]

It is part of neuromuscular medicine fellowships (and board exam) to learn to interpret nerve and muscle biopsies. It depends on the program whether you learn how to obtain the biopsy or not.

 

[xenotype]

Muscle biopsies would typically be done by a surgeon. I would question why a neurologist is doing these with no experience performing excisional biopsies and closing skin for appropriate cosmesis. Not that this is a very difficult procedure, but that a surgeon is by definition going to be better at doing it in all cases. Perhaps my experience at multiple large institutions is unique in that regard having never seen a single neurologist doing these. Interpretation of the biopsies is part of NM/CNP fellowships but formally done by pathologists. Nerve biopsies should be rare these days as they can cause chronic neuropathic pain and are often not needed for an accurate diagnosis particularly with genetic testing widely available. The most common would actually be a biopsy to diagnose small fiber neuropathy which is a simple small punch that literally a cave man could do.

 

[Thama]

Muscle biopsies and skin biopsies were commonly done by neuromuscular-trained neurologists at my large training institution, and training to close a small wound in a location where cosmesis isn't vital isn't rocket science. If a (large) nerve biopsy was also needed it was a surgical consult.

 

[JBM16BYU]

I will add that at some institutions that nerve and muscle biopsy interpretation is performed by the neuromuscular physician (ex. Mayo Clinic) and not by a pathologist. This may just be institution-dependent.

 

[DrSatan]

I've seen all of the above. I would never personally want to do a muscle biopsy, it looked so mideival!