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physiotherapy case study kano state surgery nigeria physical therapy physiotherapy management management knee osteoarthritis knee pain pathological fractures muscle weakness upper limb right upper limb function impairment orthopaedics complication post surgical complication cancer multiple myeloma myeloma stress repair vvf vesicovaginal fistula urinary incontinence incontinence healthcare medicine presentation myathenia gravis palsy bulbar palsy dysphonia dysphagia medical management orofacial diabetic nephropathy nephropathy diabetes case report pathophysiology neck pain cervical spondylosis