Figures 4d-4g: The same patient as in Figure 4a-4c aged 60. Re-examination in 24 years after the first examination. Asymmetry of the lips when puckering them to whistle (d), severe weakness of the trapezius and serratus anterior muscles (e), inability to stand up on the heels is seen more clearly on the left side (f), the patient can stand up on his toes (g).