• motor neuron disease
• incl body myositis

A 67-year-old man was referred for suspected motor neurone disease. He had a 2-year history of slowly progressive reduction in fine motor skills of his left hand, difficulties climbing stairs and slight dysphagia (for solids). His history included necrotising pancreatitis, diabetes mellitus and hypertension, and he took antihypertensive medication, insulin and a statin.

On examination, he had muscle atrophy of the distal arm. The band of his wrist watch showed the wear and tear of sequentially used holes (figure 1 solid arrow) suggesting slowly progressive muscular atrophy. His nails were still visible on making a fist, indicative of weakness of the deep finger flexors (figure 1 …