Millinero,
There is a shoulder girdle onset of ALS; but it still considered as limb onset.
"Initial presentation and patient complaints — Asymmetric limb weakness is the most common presentation of ALS (80 percent). Upper extremity onset is most often heralded by hand weakness but may begin in the shoulder girdle muscles. Patients with hand weakness may complain that they drop things and have difficulty performing fine motor tasks such as pinching, writing, typing, managing buttons or zippers, and picking up small objects such as coins and paper clips. Patients with shoulder girdle weakness may report difficulty using their arms above the head in activities such as washing, drying, or combing their hair as well as lifting things above their head."
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