The Eighteen Tenderpoints of Fibromyalgia

Fibromyalgia is a rheumatic condition characterized by widespread soft tissue pain, fatigue, sleep disturbance, and the presence of evenly distributed areas of tenderness. Diagnosis of fibromyalgia requires a history of at least three months of widespread pain and tenderness in eleven or more of the eighteen designated tenderpoint sites. The definition of widespread pain consists of pain above and below the waist, on the left and right sides of the body, and pain along the axial skeleton.

The eighteen tenderpoints consist of nine bilateral sites adding up to eighteen in total. Pain must be experienced upon palpation in at least eleven of these eighteen sites for a diagnosis of fibromyalgia to be made. The nine bilateral tenderpoint locations consist of the:
*Occiput: at the insertions of one or more of the following muscles- trapezius, sternocleidomastoid, splenius capitus, semispinalis capitus
*Low cervical region: at the anterior aspect of the interspaces between the transverse processes of C5-C7
*Trapezius muscle: at the midpoint of the upper border
*Supraspinatus muscle: above the scapular spine near the medial border
*Second rib: just lateral to the second costochondral junctions
*Lateral epicondyle: 2 cm distal to the lateral epicondyle
*Gluteal: at the upper outer quadrant of the buttocks at the anterior edge of the gluteus maximus muscle
*Greater trochanter: posterior to the greater trochanteric prominence
*Knee: at the medial fat pad proximal to the joint line

The above eighteen tenderpoints have been established by the American College of Rheumatology. If you have experienced widespread pain for at least 3 months in eleven of the above eighteen tenderpoints discuss the posibility of fibromyalgia with your physician.