Muscle Biopsy

Muscle biopsy

Muscle biopsy is a procedure of extraction of the muscle tissue and it is analyzed in the laboratory by a pathologist, this procedure can be necessary after performing other complimentary test. It is used to diagnose neuromuscular disorders, metabolic muscle diseases, inflammatory disorders, and certain genetic diseases. 

Types of Muscle Biopsy

Needle (Closed) Muscle Biopsy 

• Takes a tiny piece of tissue by using a special hollow needle. 
• It is also minimally invasive.
• Leaves a very small scar.
• Normally under local anaesthetic.

Open (Surgical) Muscle Biopsy

• A larger portion of tissue is excised via a small cut. 
• Gives a more comprehensive and better specimen.
• Performed in cases of an inadequate or inconclusive needle biopsy.
• Depending on the location and the patient, local or general anaesthetic should be applied.

Indications (Why It’s Done)

Muscle biopsy is advised in the cases of:

• Weakness of the muscles without a known cause.
• Sore or cramping muscles that persist for a long time.
• High creatine kinase levels. 
• Suspected inflammatory myopathies.
• Muscular dystrophies suspected.
• Metabolic muscle disorders
• Neuropathies with possible implications on muscle structure.
• Congenital myopathies

Muscle biopsy procedure

Muscle biopsy is a test used for diagnosis in which a small piece of muscle tissue is taken from the body for analysis in the laboratory. It is used to detect nervous system related, inflammatory, metabolic, congenital, and inherited muscle diseases. 

Two kinds of procedures are distinguishable: 

• Needle (closed) muscle biopsy
• Open (surgical) muscle biopsy 

The step by step outline of both is presented below.

Pre Procedure Preparation

Medical Assessment

• Assessment of symptoms, distribution of weakness, and history.
• Blood samples tests 
• Image (MRI or ultrasound) to select the best muscle.

Reviews of Medicine

• You may have to stop taking your blood thinners (aspirin, warfarin, clopidogrel) temporarily. 
• Avoid NSAIDs 24 -48 hours before as recommended.

Fasting

• Not necessary in needle biopsy.
• Open biopsy may need to be performed with general anaesthesia.

Site Selection

A more or less weak muscle is normally selected:

• Thigh (quadriceps)
• Upper arm (deltoid)
• Calf (gastrocnemius)

Badly wasting or injected muscles are shunned.

Needle Muscle Biopsy (Closed Biopsy)

Procedure Steps:

Positioning

• Lies are comfortable depending on the muscle chosen by a patient.

Local anaesthesia, skin cleaning

• Local anaesthetic and area sterilization is done.

Small skin incision

• A tiny incision (2–3 mm) may be made.

Insertion of biopsy needle

• A hollow needle is implanted in the muscle.

Tissue sampling

• A needle is used to take a small cylinder of muscle tissue (core sample).
• Several transfers can be made to get sufficient tissue.

Sample preservation

Tissue will be put in containers:

• Routine histopathology
• Enzyme analysis
• Immunohistochemistry
• Genetic tests
• EM (where necessary)

Closure

• A simple bandage is normally sufficient. No stitches required.

Time required:

• 10–15 minutes

Aftercare

• Mild soreness for 1–2 days
• Bandage left for 24 hours
• Limit the activity to 48 hours.

Open Muscle Biopsy (Surgical Biopsy)

Open biopsy is carried out in case of:

• A bigger and quality sample is required.
• Past needle biopsy inconclusive.
• There are specific conditions (such as mitochondrial disease) which require larger samples.

Procedure Steps

Positioning and anaesthesia

• Local anaesthesia for adults
• General anaesthesia of children or anxious patients.
• Washing and sterilization of the skin

Incision

• A small incision (1-3 cm) is done on the chosen muscle.

Muscle exposure

The separation of the muscle fibers is done without causing harm to neighbouring tissues.

Tissue removal

• Only a small part of muscle (0.5-1 g) is excised.

Sample handling

Tissue is instantly cut into:

• Fresh sample (enzyme assays)
• Sample (genetic/metabolic examination) frozen.
• Fixed sample (histopathology)

Closure

• Muscle layer is closed
• The skin is sewed with a thread.
• Sterile dressing is applied

Time required:

• 20–30 minutes

Aftercare

• Stitches removed in 7–10 days
• Bruising or pain of 2-3 days.
• Keep the area clean and dry
• Abstinence of heavy exercise 1 week.

Muscle biopsy recovery

A muscle biopsy does not have a complicated recovery period. The healing period is determined by the type of biopsy performed, i.e. needle (closed) or on the other hand on the type of biopsy performed (surgical), but the majority of patients are back to normal with a few days.

Short-term Post-Operative Rehabilitation

Observation

• Incidentally, you can be observed between 15 to 30 minutes after the procedure.
• Vital signs are monitored; dressings examined to see whether they are bleeding.

Pain

• As a rule, slight discomfort or soreness at the site of biopsy may appear.

Treatment of pain is typically managed with:

• Paracetamol
• Use cold packs (10-15 minutes, as recommended).
• There is no need to use NSAID without permission (it can contribute to the risk of bleeding).

Wound Care

Needle Biopsy

• A small bandage only is used.
• Keep the area dry for 24 hours.
• No stitches needed.

Open Biopsy

• Stitches are covered with sterile dressing.
• Keep dressing dry for 48 hours.
• Stitches are removed in 7–10 days.
• It can shower after 24-48 hours (depending on doctor recommendation) without scrubbing the area.

Activity Restrictions

• First 24–48 Hours
• Avoid strenuous activity.
• No heavy lifting.
• No weight lifting of the biopsied muscle.

For Needle Biopsy

• The majority of individuals get back to normal activities within 1- 2 days.

For Open Biopsy

• The normal functions are resumed in 3-5 days.
• Exercise can be returned to normal after 1 week, again, at the approval of the doctor.

Long-Term Recovery

Scarring:

• Minimal with needle biopsy
• Scars may be small and there may be an open biopsy.

Sensation changes:

• This may sometimes be temporary numbness around the incision.
• Typically remits in a few weeks to months.

No long-term weakness:

• The loss of a bit of muscle does not have any impact on strength and functioning.

Muscle biopsy complications

Muscle biopsy is a relatively low-risk and safe procedure. Majority of the complications are mild and transient. There is a slight difference on the risks associated with needle biopsy and open (surgical) biopsy.

Common, Mild Complications

• Pain or Soreness
• Bruising (Hematoma)
• Swelling

Wound-Related Complications

• Bleeding
• Infection
• Wound Dehiscence (Open Biopsy Only)
• Scarring

Nerve-Related Complications

• Temporary Numbness or Tingling
• Nerve Injury (Very Rare)

Muscle-Related Complications

• Local Muscle Stiffness
• Persistent Pain (Rare)
• Muscle Herniation (Extremely Rare)

Best hospital for muscle biopsy India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Conclusion

Muscle biopsy is a highly effective and useful diagnostic test that is utilized to assess many different muscle diseases such as inflammatory; metabolic, congenital, and genetic. Depending on the clinical requirement, the procedure can be done with a needle or by a minor surgical opening. The biopsy is often well tolerated by the majority of patients, and the recovery is fast and relatively painless. The complications are rare and mild in nature. The data of the biopsy contains the important information about the structure of the muscle, inflammation, degeneration, and abnormalities of biochemicals- which allows clinicians to make correct diagnosis and provide the optimal treatment.

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FAQ

Is a muscle biopsy painful?

• The process is done under local anaesthesia, so you won't feel any pain at any point during the biopsy. Slight soreness or pain may be noticed afterward but it usually lasts just a few days.

Is hospitalization needed?

• No. Most muscle biopsies are day care procedures. Generally no hospitalization is necessary.

Will I have a scar?

• Needle biopsy: Usually no visible scar.
• Open biopsy: A small scar (1-3 cm) may remain.

Can I exercise after the biopsy?

• Don't use the biopsied muscle strenuously for 48 to 72 hours after a needle biopsy and for 1 week after an open biopsy.

Will a biopsy affect my muscle strength?

• No. Taking a small sample of muscle tissue doesn't produce long-term weakening or loss of function.