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Nishant prestation 1


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Nishant prestation 1

  1. 1. Paget's disease of bone<br />Known as osteitisdeformans<br />A chronic disorder that typically results in enlarged and deformed bones<br />Paget's disease can cause bone to weaken,<br />Bone pain<br />The excessive breakdown and formation of bone tissue<br />arthrites <br />deformities,<br />
  2. 2. cause<br />Virus infections<br />Canine distemper virus<br />Respiratory syncytial virus<br />Paramyxovirus <br />
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  7. 7. Symptoms<br />Bone pain is the most common symptom <br />Headaches and hearing loss may occur when Paget's disease affects the skull <br />Pressure on nerves may occur when Paget's <br /> disease affects the skull or spine. <br />Drowsiness <br />
  8. 8. Symptoms<br />Increased head size<br />Curvature of spine may occur in advanced cases<br />Hip pain may occur when Paget's disease affects the pelvic or thigh bone<br />Damage to joint cartilage may lead to arthrities<br />Teeth may spread intraorally<br />Chalkstik #: Chalkstick fractures are fractures, typically of long bones, in which the fracture is transverse to the long axis of the bone, like a broken stick of chalk. <br />
  9. 9. Diagnosis<br />
  10. 10. Diagnosis<br />
  11. 11. Skull radiograph<br />cotton wool" appearance of the cranial vault<br />
  12. 12. Radiograph of left femur<br />Bone with cortical thickening<br />
  13. 13. Treatment<br /><ul><li>Drug Therapy
  14. 14. Surgery
  15. 15. Diet & Exercise</li></li></ul><li>Drug Therapy<br />Bisphosphonates<br />Five bisphosphonates are currently available.<br />Didronel (etidronate disodium) -- Tablet; approved regimen is 200–400 mg once daily for 6 months; <br />Aredia (pamidronate disodium) -- Intravenous; approved regimen 30 mg infusion over 4 hours on 3 consecutive days;<br />Fosamax (alendronate sodium) -- Tablet; 40 mg once daily for 6 month<br />
  16. 16. Bisphosphonates<br />Skelid (tiludronate disodium) -- Tablet; 400 mg (two 200 mg tablets) once daily for 3;<br />Actonel (risedronate sodium) -- Tablet; 30 mg once daily for 2 months; <br />
  17. 17. Calcitonin<br />Miacalcin is administered by injection; 50 to 100 units daily or 3 times per week for 6-18 months<br />
  18. 18. Surgery<br /><ul><li>There are generally two major complications of Paget's disease for which surgery may be recommended.</li></li></ul><li>Surgery<br />Severe degenerative arthritis -- If disability is severe and medication and physical therapy are no longer helpful, joint replacement of the hips and knees may be consider <br />Bone deformity -- Cutting and realignment of Pagetic bone (osteotomy) may help painful weight bearing joints, especially the knees.<br />
  19. 19. Diet and Exercise<br />Patients with Paget's disease should receive 1000-1500 mg of calcium<br />Adequate sunshine<br />At least 400 units of vitamin D daily<br />This is especially important in patients being treated with bisphosphonates. <br />
  20. 20. Exercise<br /> Avoiding weight gain <br />Maintaining joint mobility<br /> Flexibility exercises, such as stretching, improve the range of motion of muscles and joints<br />Undue stress on affected bones should be avoided <br /> Relieve of pain<br />
  21. 21. SHOULDER EXERCISE<br />The shoulder shrug is another technique that may improve posture and reduce back pain <br />Begin by standing erect with dumbbells or water bottles held at the sides of the body<br />Lift the shoulders toward the head by elevating the shoulder girdle, and slightly retract the scapulae to rotate the shoulders back<br />
  22. 22. SHOULDER EXERCISE<br />Pause, and then return to the starting position.<br /> Avoid rocking or using the legs to initiate the exercise by slightly bending your knee <br />Repeat the exercise three to five times<br />
  23. 23. KNEE EXCERCISE<br />A good starting point is the squat which targets the gluteals, hamstrings, and quadriceps<br />Start by standing erect with a neutral spine and feet shoulder-width apart<br />Slowly lower the body, with the hips moving back as if sitting in a chair.<br />
  24. 24. KNEE EXCERCISE<br /><ul><li>Maintain the weight directly over the heels or mid-foot
  25. 25. Lower to approximately 90 degrees of knee flexion.
  26. 26. Pause, and then slowly return to the starting position
  27. 27. Remember to keep the weight over the back portion of the foot rather than the toes; raise the arms to shoulder height to counterbalance.</li></li></ul><li> KNEE EXCERCISE<br />Repeat the exercise three to five times <br />If you have trouble lowering your body until 90 degrees of knee flexion consider placing a chair behind you with some pillows in the chair.<br />  <br />This way, you can lower your body until about 70 degrees of knee flexion (or until you feel the pillows on the chair), pause at that amount of knee flexion, and then return to starting position<br />
  28. 28. KNEE EXCERCISE<br />The heel raise is another good exercise that targets the gastrocnemius and soleus<br />Plantarflex up (stand on the toes) pause, then slowly lower to the starting position.<br />Lastly the knee to chest technique is a great maneuver to help stretch the lower extremity and prevent cramping <br />
  29. 29. KNEE EXCERCISE<br />Lie on your back and pull one knee to your chest.<br />Perform 1-2 sets of 3-5 repetitions per side<br />Each repetition should last 15-30 seconds<br />