In a series of over 400 patients seen for progressive amyotrophies, two patients had a benign course. This type of amyotrophy should be entertained as a diagnostic possibility in selected patients with early amyotrophic lateral sclerosis (ALS).
Report of Cases
CASE 1.—A 49-year-old salesman ran full-tilt into a wall in September 1966, and sustained diffuse injury to the right anterior shoulder and upper arm; a massive ecchymosis extended from clavicle to elbow. The latter resolved during the next month, but local muscular tenderness and pain on movement continued several months. Orthopedic consultation and x-ray films of the neck and shoulder revealed no bone or joint abnormality. This local injury had not cleared entirely when six months later he noted further weakness in the right shoulder and arm. There was proximal and distal weakness with difficulty manipulating a pencil. During the next year the weakness progressed; wasting and fasciculation developed