Nerve biopsy

Definition

A nerve biopsy is the removal of a small piece of a nerve for examination.

Alternative Names

Biopsy - nerve

How the Test is Performed

A nerve biopsy is most often done on a nerve in the ankle, forearm, or along a rib.

The health care provider applies medicine to numb the area before the procedure. The doctor makes a small surgical cut and removes a piece of the nerve. The cut is then closed and a bandage is put on it. The nerve sample is sent to a lab, where it is examined under a microscope.

How to Prepare for the Test

Follow your provider's instructions on how to prepare for the procedure.

How the Test will Feel

When the numbing medicine (local anesthetic) is injected, you will feel a prick and a mild sting. The biopsy site may be sore for a few days after the test.

Why the Test is Performed

Nerve biopsy may be done to help diagnose:

• Axon degeneration (destruction of the axon portion of the nerve cell)
• Damage to the small nerves
• Demyelination (destruction of parts of the myelin sheath covering the nerve)
• Inflammatory nerve conditions (neuropathies)

Conditions for which the test may be done include any of the following:

• Alcoholic neuropathy (damage to nerves from excessive drinking of alcohol)
• Axillary nerve dysfunction (damage to the shoulder nerve that leads to a loss of movement or sensation in the shoulder)
• Brachial plexopathy (damage to the brachial plexus, an area on each side of the neck where nerve roots from the spinal cord split into each arm's nerves)
• Charcot-Marie-Tooth disease (inherited group of disorders that affect the nerves outside the brain and spine)
• Common peroneal nerve dysfunction (damage to the peroneal nerve leading to loss of movement or sensation in the foot and leg)
• Distal median nerve dysfunction (damage to the median nerve leading to loss of movement or sensation in the hands)
• Mononeuritis multiplex (disorder that involves damage to at least two separate nerve areas)
• Necrotizing vasculitis (group of disorders that involve inflammation of the blood vessel walls)
• Neurosarcoidosis (complication of sarcoidosis, in which inflammation occurs in the brain, spinal cord, and other areas of the nervous system)
• Radial nerve dysfunction (damage to the radial nerve leading to loss of movement or sensation in the arm, wrist or hand)
• Tibial nerve dysfunction (damage to the tibial nerve leading to loss of movement or sensation in the foot)

Normal Results

A normal result means the nerve appears normal.

What Abnormal Results Mean

Abnormal results may be due to:

• Amyloidosis (sural nerve biopsy is most often used)
• Demyelination
• Inflammation of the nerve
• Leprosy
• Loss of axon tissue
• Metabolic neuropathies (nerve disorders that occur with diseases that disrupt the chemical processes in the body)
• Necrotizing vasculitis
• Sarcoidosis

Risks

Risks of the procedure may include:

• Allergic reaction to the local anesthetic
• Discomfort after the procedure
• Infection (a slight risk any time the skin is broken)
• Permanent nerve damage (uncommon; minimized by careful site selection)

Nerve biopsy is invasive and is useful only in certain situations. Talk to your provider about your options.

References

Chernecky CC, Berger BJ. Nerve biopsy - diagnostic. In: Chernecky CC, Berger BJ, eds. Laboratory Tests and Diagnostic Procedures. 6th ed. St Louis, MO: Elsevier Saunders; 2013:814-815.

Midha R, Elmadhoun TMI. Peripheral nerve examination, evaluation, and biopsy. In: Winn HR, ed. Youmans and Winn Neurological Surgery. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 245.