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Department of Histopathology Addenbrookes Hospital Box 235 Cambridge CB2 0QQ Direct Dial: 01223 348171 Fax: 01223 216980 MUSCLE / NERVE BIOPSY REQUEST FORM * Mandatory Questions *Please tick IN PATIENT

How to fill out muscle nerve biopsy request

How to fill out a muscle nerve biopsy request:

1. Collect patient information: Start by filling out the patient's full name and contact information. This includes their address, phone number, and email.
2. Provide medical history: Write down relevant medical history information, including any pre-existing conditions, previous surgeries, or current medications. This helps provide context for the decision to request a muscle nerve biopsy.
3. Indicate the reason for the request: Clearly state why the muscle nerve biopsy is being requested. This could be to diagnose a specific condition, assess nerve damage, or evaluate muscle abnormalities.
4. Specify the location and type of biopsy: Identify the specific muscle or nerve that needs to be biopsied. Additionally, specify whether it will be an open biopsy or a minimally invasive procedure such as needle biopsy.
5. Include any relevant test results: If there have been previous tests or imaging studies conducted that are relevant to the muscle nerve biopsy request, make sure to attach copies of the results or mention them in the request form.
6. Provide any additional information: If there are specific concerns, questions, or additional information that would assist the physician or surgeon in evaluating the muscle nerve biopsy request, include it in a separate section or addendum.

Who needs a muscle nerve biopsy request:

1. Patients with unexplained muscle weakness or atrophy: Muscle nerve biopsies are often requested for patients who present with symptoms such as muscle weakness, stiffness, or loss of muscle mass that cannot be explained by other diagnostic tests.
2. Individuals with suspected neuromuscular disorders: In cases where a neuromuscular disorder is suspected, a muscle nerve biopsy may be necessary to confirm the diagnosis and assess the severity or progression of the condition.
3. Patients with peripheral neuropathy: Peripheral neuropathy refers to damage or dysfunction of the nerves outside of the brain and spinal cord. Muscle nerve biopsies can aid in determining the underlying cause of peripheral neuropathy and guide treatment decisions.
4. Those with suspected muscle tissue abnormalities: If there are concerns about muscle tissue abnormalities, such as inflammation, fibrosis, or infection, a muscle nerve biopsy can provide valuable information for diagnosis and treatment planning.
5. Individuals with an unexplained dermatomyositis or polymyositis: Dermatomyositis and polymyositis are inflammatory conditions that affect the muscles and skin. Muscle nerve biopsies help in confirming these conditions and assessing the extent of muscle involvement.
6. Patients with suspected nerve or muscle damage: When there is suspicion of nerve or muscle damage due to trauma, compression, or other causes, a muscle nerve biopsy can help determine the extent and nature of the damage, aiding in appropriate management.

Remember to consult with a medical professional and follow their guidance for completing a muscle nerve biopsy request accurately and in compliance with the specific requirements of the healthcare facility or laboratory.

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