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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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