All this good info...I heard somewhere that the sural nerve biopsy was outdated but for what reason I have no idea....no help here. NOW i am confused....I specifically asked if I was getting "small fiber biopsy" is that different from "punch biopsy"? I can't remember which doctor told me it would be the small fiber one but is that the same thing????? I had the EMG and NCS and the were normal of course. Negative for Myathanis gravis. So what about this arm fatigue. Darn it. I don't really notice much pain till I go to bed. My feet have been burning and nasty feeling for years, but has not spread and they say it is not "neuropathy". I always seem to have too many sx for anyone to handle. Well I can't either but I want to try to figure it out. Darn, I have insurance, are docs just giving up ???????? Today my left hand was tingling then my thumb started twithching for a few minutes .....now what. I had a bad pain attack in left arm last fall all the way from first 3 fingers to side of head, said its not TOS< no answer on that either. My right hand is in a splint so I think the overuse of left is causing pain and sx from the original thing that happened whatever it was. Pain lasted a few weeks then finally subsided...flared up if slept on but now kiinda gone except the hand pain now....and the tingles today...