Diagnostic Studies: Biopsy: Nerve

The 26 Review

  • What is a Nerve Biopsy A diagnostic procedure where a small sample of nerves are removed from the ankle for analysis
  • How This biopsy removes a sensory nerve from the skin.
  • Why  To aid in diagnosing or determining treatment
  • Recommended For  Patients who are experiencing numbness, tingling, pain and/or weakness within their feet
26 Foot and Ankle Vascular Neuropathy Electrical Stimulation

Let’s take a closer look…

This type of diagnostic study is utilized to assess the nerve or nerve fibers within the surface of skin layers. Typically these nerves are removed from the ankle or the shin. Based on the analysis of the nerves, it aids medical professionals when diagnosing ailment a patient is battling. Some symptom causers can include damage to the myelin sheath, damage to the small nerves, neuropathies, and the destruction of the axon, fiber-like nerve extensions. Numerous conditions and nerve dysfunctions can affect a patient’s nerves. A common condition doctors order nerve biopsies for include neurotherapy and  peroneal nerve dysfunctions, such as drop foot. This biopsy would be performed with local anesthetic nerve blocks in the area of the biopsy. After the sample has been obtained the procedure site will be wrapped with a small compressive wrap, while the sample is sent off for testing. To learn more about nerve biopsies continue reading on.

What to Expect

There is not a ton of preparation needed for a nerve biopsy. The medical professional may conduct a physical examination and blood tests prior to beginning the procedure. Patients will be administered nerve block anesthetic that numbs the affected area. Following, the doctor will make a small surgical incision, in order to remove a small portion of the nerve. This can cause temporary or permanent numbness to the part of, the top, or side of the foot. After, the punch site is covered with a Bandaid, while the sample is sent to the laboratory for testing. 

Pros and Cons

After the nerve biopsy patients will be free to leave the doctor’s office the same day. The main benefit of a nerve biopsy is that it’s one of the best diagnostic tools for numerous conditions and nerve dysfunctions. It can take up to two weeks for results to come back from the laboratory. When the biopsy results come back, the medical professional will schedule a follow-up appointment to discuss the results. Depending on the results, a patient may need more tests or treatments for their condition. The major risk associated with a nerve biopsy is long-term nerve damage, however this is incredibly rare. It is common for a small area around the biopsy to remain numb for 6 to 12 months following the procedure. In certain cases, the loss of feeling can become permanent, but most people are not bothered due to the small location. Other risks can include discomfort, infection and allergic reactions to the anesthetic. Speaking to a doctor about how to minimize risks is a great prevention method. 

Small Fiber Neuropathy & Diagnosis

Small Fiber Neuropathy is a disorder where the small sensory nerves are affected. The large majority of patients experiencing this disorder find that sensory disturbances begin in the feet and progress upwards. SFSN is characterized by severe pain attacks, however individuals usually can not feel pain in very small, concentrated areas. Typically patients have an increased sensitivity to pain in general and feel pain from simulation that doesn’t normally cause pain. People who experience this disorder oftentimes have a reduced ability to differentiate between hot and cold sensations, even though pain attacks can be provoked by cold or hot triggers. These attacks usually consist of pain described as stabbing or burning, and/or abnormal skin sensations, such as itching or tingling. Some individuals claim their symptoms worsen while resting, sleeping or at night in general. The signs and symptoms of small fiber neuropathy can affect people of all ages, but usually start to appear in adolescence to mid-adulthood. 

The Epidermal Nerve Fiber Density (ENFD) test is a skin punch biopsy used to diagnose small fiber neuropathy. This test aims to measure the density of the small sensory nerve fibers in the skin. Skin specimens are obtained by using a 3 mm punch biopsy at standard sites, such as the arm, the thigh, the calf and the dorsum of the foot. The specimen is then stained and prepared for examination by a pathologist, who evaluates the amount and structural integrity of the small fibers. Small fiber neuropathy is identified by the decrease of the intraepidermal nerve fiber density or structural abnormalities. This biopsy procedure is simple to perform and typically takes 5 to 10 minutes to complete, with little discomfort. This test offers unique advantages over other tests due to the ENFD test revealing any and all damage present in the small nerve fibers. 

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