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Myopathies are heterogenous and can provide a diagnostic puzzle. Many patients investigated for myopathy will go on to other diagnoses. An overall understanding of how patients are investigated for suspected myopathy is lacking. Our aim was to understand how patients were investigated for myopathy in our tertiary centre and the timeline of their diagnostic journey. Through local database searches over a 5-year period (2015-2019), we identified a final total of 770 patients investigated for myopathy. Of these, 29.7% went on to a diagnosis of myopathy. The top non-myopathy diagnoses were neuropathy, spinal pathology and ataxia. Both the myopathy and non-myopathy groups had symptoms for an extended period before reaching specialist services (both groups 104 weeks). Following a first hospital visit, median time to diagnosis was not significantly different (myopathy 46.9 weeks, non-myopathy 40.7 weeks, p > 0.05). Data on the diagnostic journey for specific myopathies was also collected, with inflammatory myopathies diagnosed most quickly and muscular dystrophies most slowly. Muscle MRI and biopsy had the best positive predictive values (82.7% and 83.1%, respectively), while EMG had the best negative predictive value (89.3%). A combination of CK, EMG and neuroaxis MRI (brain and spinal cord) yielded at least one correct test result with respect to final diagnosis in 98.9% of cases. In conclusion, patients in whom a muscle disease is considered experience significant diagnostic delay. The first step in the diagnostic journey should be able to identify both myopathy and non-myopathy cases., Competing Interests: Declarations. Conflicts of interest: None. Ethical standard: The project was registered and granted the necessary approvals as a service evaluation by Sheffield Teaching Hospitals NHS Foundation Trust., (© 2024. The Author(s).)