Fibromyalgia Tender Points As Diagnostic Criteria
Fibromyalgia is characterized by a number of variable symptoms. As the name suggests, the primary symptom is pain. The term itself means “fibro”-fibrous tissues (tendons and ligaments), “my”- muscles and “algia”- pain. Fibromyalgia tender points are the primary official diagnostic criteria as established by the American College of Rheumatology are:
A history of widespread pain, lasting longer than three months
Pain in 11 of 18 the fibromyalgia tender points on Palpation at the following sites:
Occiput: Bilateral, at the sub occipital muscle insertions.
Low cervical: bilateral, at the anterior aspects of the intertranverse spaces at C5-C7.
Trapezius: bilateral, at the midpoint of the upper border.
Supraspinatus: bilateral, at origins, above the scapula spine near the medial border.
Second rib: bilateral, at the second costochondral junctions, just lateral to the junctions of the upper surfaces.
Lateral epicondyle: bilateral, 2cm distal to the epicondyles.
Gluteal: bilateral, posterior to the trochanteric prominence.
Knee: bilateral, at the medial fat pad proximal to the joint line.
The American College of Rheumatology Criteria for A Fibromyalgia diagnosis, developed in 1990. Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia: report of the multicenter criteria committee. Arthritis Rheum 1990;33:160-72.
IN MORE READILY UNDERSTANDABLE TERMS THE TENDER POINTS ARE LOCATED IN THESE AREAS:
either side of the upper back or spine, at the junction between the neck or cervical area and the shoulders.
either side of the posterior neck below the hairline.
either side of the chest area below the collar bone area.
either side of the back area that lies between the shoulder blades.
either side of the lumbar back area (lower back), below the waistline.
either knee cap area.
either side of the buttocks area beneath the area of the hips.
the inside areas of either arm at the elbow area.
The following is a visual representation of the locations of the tender points.
According to the American College of Rheumatology, the full diagnostic criteria include the requirement that the palpation of the tender point should be performed with approximately 4kg of force and the patient must indicate that the palpation hurt. An indication that the point is tender is not sufficient to meet the ACR criteria.
Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia: report of the multicenter criteria committee. Arthritis Rheum 1990;33:160-72.