The diagnostic exam in which the doctor palpates the eighteen tender points characteristic of FM relies solely on the patient’s report of pain when pressed in these areas.
Generally, the American College of Rheumatology criteria of 1990 states eleven of the 18 tender points should be noted. It is important to say here that the tender point model was developed as a tool for studying fibromyalgia, not as the diagnostic tool used today.
Unlike other disease processes, the symptoms of fibromyalgia affect all four quadrants of the body equally. There have been disputes over the tender point exam because patients may have tender points in other parts of the body, or not in the particular points on the tender point model, yet they experience all of the symptoms that are compatible with a diagnosis of fibromyalgia. Because of this, the preliminary diagnostic criteria was proposed to the American College of Rheumatology in 2010.
Some rheumatologists believe what we think of as tender points are related to a condition called myofascial pain syndrome, where knotted up pieces of muscle fiber can be felt, are painful, restrict motion, and radiate pain in a particular referral pattern. The trigger points of myofascial pain syndrome are considered as neurological imitators, and could explain the neuropathic symptoms many fibromyalgia patients experience. While it is a separate condition from fibromyalgia with it's own diagnostic criteria, myofascial pain syndrome should be considered as a comorbid condition, just as it is to other overlapping conditions with fibromyalgia, interstitial cystitis, restless leg syndrome, migraine, chronic pelvic pain, TMJ and teeth grinding.
If you suspect you have fibromyalgia, see a physician that specialized in diagnosis.