To the Editor.
—In a letter to the editor, Riggs1 described a 33-year-old man in whom amyotrophic lateral sclerosis (ALS) developed nine months after he suffered a traction injury to his upper extremity while trying to save himself from falling off a railroad car. The onset of ALS following a severe pull of one or both upper extremities away from the shoulder has been described before, as detailed below.
—Probst2 described a 37-year-old woman whose hand became caught in a machine; the rest of the extremity was soon drawn up into the equipment, resulting in a violent jerking of the arm away from the shoulder. She felt local pain for a while and was well until 36 months later, when she developed signs and symptoms of ALS. Astwazaturow3 wrote about a 46-year-old man who sustained a severe pulling injury to his arm while trying to accelerate the movement
Gallagher JP. Amyotrophic Lateral Sclerosis Following Arm Trauma. Arch Neurol. 1986;43(8):755. doi:10.1001/archneur.1986.00520080007003
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