1. Signs and Symptoms Proximal atrophy, distal hypertrophy, calf atrophy, twitching, one for the road Erik Ensrud, M.D. Boston VAMC/Brigham and Women’s

2. Case 1 Atrophic Quad

3. 71 yom comes to your clinic for “gait difficulty” and LBP (non-radiating) Reports slow onset of difficulty with gait Difficult getting out of chairs and off the toilet seat You ask about UE c/o’s? – Difficulty grasping heavy objects…he dropped his grandkid’s favorite toy and it broke-not good Normal UE strength- SA/EF/EE/FDI/APB 4+/5 hip flexion L/R 4/5 knee extensors, knee flexors are fine ADF/APF fine Able to get OOC only with use of arms

4. Case 2: 32 yom, mild muscle pain What’s your differential? Enlarged calves

5. Case 3:What is this? Pic of medial calf atrophy

6. What is this? Fasciculating Face

7. One for the Road-what is this Video Thanks erikensrud@va.gov