FM/CFS/ME RESOURCES - FM Tender Points
 



 




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 FM TENDER POINTS

The pain of Fibromyalgia (FM) is present in the soft tissues throughout the body. Pain and stiffness concentrate in spots such as the neck and lower back. The tender spots don't seem to be inflamed, nor do they display the typical signs of discomfort, such as heat, redness, or swelling. Most tests show nothing out of the ordinary in the anatomy of people with FM.

The FM tender points consist of nine bilateral sites adding up to 18 in total. The picture below and to your right shows the 18 tender point sites that have been identified by the American College of Rheumatology (ACR). According to the ACR criteria, FM is present when a patient suffers widespread pain for at least three months and feels pain in 11 or more of the 18 pressure point sites.

Doctors measure these tender points in one of two ways:

  • By pressing the site with a finger or
  • By using a slightly higher-tech method called dolorimetry

In the dolorimetry method, the examiner presses a rubber endplate, attached to a spring-loaded force gauge, into the tender point site with increasing force. Patients are then asked to say when they stop feeling pressure and start feeling pain.

The 18 Tender Points of Fibromyalgia exist at these nine bilateral muscle locations:

  • Low Cervical Region: (front neck area) at anterior aspect of the interspaces between the processes of C5-C7.

  • Second Rib: (front chest area) at second costochondral junctions.

  • Occiput: (back of the neck) at suboccipital muscle insertions.

  • Trapezius Muscle: (back shoulder area) at midpoint of the upper border.

  • Supraspinatus Muscle: (shoulder blade area) above the medial border of the scapular spine.

  • Lateral Epicondyle: (elbow area) 2 cm distal to the lateral epicondyle.

  • Gluteal: (rear end) at upper outer quadrant of the buttocks.

  • Greater Trochanter: (rear hip) posterior to the greater trochanteric prominence.

  • Knee: (knee area) at the medial fat pad proximal to the joint line.

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Source:

  • The american college of rheumatology 1990 criteria for the classification of fibromyalgia, Frederick Wolfe, Hugh A. Smythe, Muhammad B. Yunus, Robert M. Bennett, Claire Bombardier, Don L. Goldenberg, Peter Tugwell, Stephen M. Campbell, Micha Abeles, Patricia Clark, Adel G. Fam, Stephen J. Farber, Justus J. Fiechtner, C. Michael Franklin, Robert A. Gatter, Daniel Hamaty, James Lessard, Alan S. Lichtbroun, Alfonse T. Masi, Glenn A. Mccain, W. John Reynolds, Thomas J. Romano, I. Jon Russell, Robert P. Sheon, Arthritis & Rheumatism, Volume 33, Issue 2 , Pages160 - 172, American College of Rheumatology.
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