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Background A twelve year old female with generalised joint hypermobility (Beighton 8/9) from Noonan's syndrome presented with chronic neck pain which caused frequent headaches. Touching the trapezeii reproduced the pain and range of movement at the cervical spine was decreased. She had been managed unsuccessfully with manual techniques, mobilisation, stretches and TENS over the prior twelve months. Poor sleep due to pain caused fatigue and decreased participation in school and physical activity.

pediatric rheumatology online journal

Effect of Botulinum Toxin type-A (Botox®) on neck pain and craniocervical headaches caused by trapezius spasm in a child with generalised joint hypermobility resulting from Noonan's Syndrome