Oluwasegun O. A., PT.

Introducing @Rehabify_health Millions of Nigerians, including our parents, live with pain, disability or loss of mobility they’ve simply learned to accept. Some struggle with chronic back or knee pain. Others are recovering from strokes, injuries or surgery, often without access to proper rehabilitation. Today, we’re launching Rehabify. 🇳🇬 Because access to quality rehabilitation shouldn’t be a privilege. 💕

I'm not sure how physical therapy got watered down to "massage and exercises". Here's what actually goes on in my head during a consultation as a physiotherapist. 🧵 (Details changed to protect the patient.) 💭 means thoughts. 2/ Patient: "My right shoulder has been getting worse for 4 weeks." 💭 54, male, worsening pain. "Progressively worse" is the phrase I listen for. Mechanical shoulder pain usually goes up and down. Steady worsening makes me curious. 3/ Me: "Did anything happen before it started?"
Patient: "I saw a chiropractor for my back. He cracked my neck, and the pain started after that." 💭 Neck manipulation, then new pain. Alarm bell. Now I'm thinking about the neck and its blood vessels, not just the shoulder. 4/ Me: "Where exactly do you feel it?"
Patient: "Down my right arm, behind my shoulder blade, and tingling on the inside of my arm." 💭 Inner arm tingling points to C8/T1 nerve territory. Pain behind the scapula. Not a typical shoulder pattern. 5/ Me: "What makes it better or worse?"
Patient: "Better when I move. Worse when I rest." 💭 That's the opposite of most mechanical shoulder problems. Non-mechanical pain means I keep digging. 6/ Me: "Anything else unusual, even if it seems unrelated?"
Patient: "At the gym, only the left side of my face was sweating." 💭 No sweating on the right side of the face is anhidrosis. 7/ Me: "Any problems with your eyes?"
Patient: "My right eye is blurry." On examination: right pupil smaller, right eyelid drooping, reduced sensation in the T1 area. 💭 Ptosis + miosis + anhidrosis on the same side = Horner's syndrome. 8/ 💭 Then I check the shoulder itself: full, pain-free movement. So the shoulder isn't the problem. The pain is coming from somewhere else. 9/ 💭 What causes Horner's + scapular pain + T1 symptoms? Top of my list:
• Pancoast tumour (lung apex tumour pressing on T1 and the sympathetic chain)
• Carotid or vertebral artery dissection after neck manipulation
• Nerve root compression or cervical fracture 10/ 💭 Also on the list:
Central: brainstem stroke, syringomyelia, brain tumour
Peripheral: neck lymph nodes, aortic aneurysm, neck trauma Droopy eyelids can also come from age, opioids, anticonvulsants, eye injury, cranial nerve problems or myasthenia gravis. 11/ Next questions:
"Do you smoke?" "Any cough or coughing up blood?" "Weight loss?" "When was your last chest X-ray?" 
Then: neck red-flag questions and a full cranial nerve assessment. 💭 Each answer moves a diagnosis up or down my list. 12/ 💭 My plan:
• No shoulder treatment. This needs a doctor.
• Urgent medical review today, to rule out artery dissection
• Chest X-ray for a possible Pancoast tumour
• Safety-netting: new headache, dizziness, speech or vision change means emergency care now 13/ And if this HAD been a simple injury? I'd still think beyond the tissue:
• Biomechanics: how you move, lift and load
• Psychosocial: sleep, stress, fear-avoidance, pain beliefs
• Social : work, family, what you need to get back to 14/ Every "just a few questions" is clinical reasoning: screening red flags, building a differential diagnosis, and knowing when to refer. Physios don't just treat a body part. We treat the whole person. @Rehabify_health launches in 3 days. Are you a physiotherapist in Nigeria? Start here: physioaroundme.com/platform/… If you run a physio clinic, start here: physioaroundme.com/platform/… Are you a Nigerian doctor/hospital manager who wants to refer your patient for physical rehabilitation ? start here: physioaroundme.com/platform/… Are you in any joint or body pain ? or recovering from stroke ? Start here: physioaroundme.com/