title: EFNS review on the role of muscle biopsy in the investigation of myalgia.
abstract: BACKGROUND
  Myalgia, defined as any pain perceived in muscle, is very common in the general population and a frequent cause for referral to neurologists, rheumatologists and internists in general. It is however only rarely due to primary muscle disease and often referred from ligaments, joints, bones, the peripheral and central nervous system. A muscle biopsy should only be performed if this is likely to be diagnostically useful. At present no 'guidelines' exist.
  
  
  METHODS
  An EFNS panel of muscle specialists was set to review relevant studies from PubMed dating as far back as 1/1/1990. Only Class IV studies were available and therefore the recommendations arrived at are 'best practice recommendations' based on information harvested from the literature search and expert opinion.
  
  
  RESULTS
  Muscle cramps should be recognized while drugs, infections, metabolic/ endocrinological and rheumatological causes of myalgia should be identified from the history and examination and pertinent laboratory tests. A muscle biopsy is more likely to be diagnostically useful if myalgia is exertional and if one or more of the following apply: i) there is myoglobinuria, (ii) there is a second wind phenomenon, (iii) there is muscle weakness, (iv) there is muscle hypertrophy /atrophy, (v) there is hyperCKemia (>2-3× normal), and (vi) there is a myopathic EMG.
  
  
  CONCLUSIONS
  Patients presenting with myalgia can be recommended to have a biopsy based on careful history and examination and on simple laboratory screening.
authors.affiliation: Clinical Neurosciences, Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus.
authors.forename: T
authors.initials: T
authors.lastname: Kyriakides
authors.forename: C
authors.initials: C
authors.lastname: Angelini
authors.forename: J
authors.initials: J
authors.lastname: Schaefer
authors.forename: T
authors.initials: T
authors.lastname: Mongini
authors.forename: G
authors.initials: G
authors.lastname: Siciliano
authors.forename: S
authors.initials: S
authors.lastname: Sacconi
authors.forename: J
authors.initials: J
authors.lastname: Joseph
authors.forename: J M
authors.initials: JM
authors.lastname: Burgunder
authors.forename: L A
authors.initials: LA
authors.lastname: Bindoff
authors.forename: J
authors.initials: J
authors.lastname: Vissing
authors.forename: M
authors.initials: M
authors.lastname: de Visser
authors.forename: D
authors.initials: D
authors.lastname: Hilton-Jones
mesh_terms: D001706:Biopsy / Q000592:standards*; D015444:Exercise / Q000502:physiology; D006801:Humans; D063806:Myalgia / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D011237:Predictive Value of Tests