Where are the 18 fibromyalgia tender points located?

A Answers (6)

  • AMichael Roizen, MD, Internal Medicine, answered
    The American College of Rheumatology (ACR) has identified criteria for classification of fibromyalgia. This classification includes having pain in 11 of 18 tender points, or trigger points, on the body during an examination. The locations of the tender point sites are over the neck, shoulder blades, lower back, elbows, buttocks, knees, and other areas. The actual size of a trigger point is small, about the size of a dime. When your doctor checks for tender points, the doctor may check "control points" or nontender points on the body to make sure you don't react to these as well, or that might change the diagnosis. Some doctors use a special instrument called a doximeter or dolorimeter to apply just the right pressure on tender points during an exam.
  • These trigger points are:

    • front and back of neck
    • mid to upper back of the shoulders
    • upper chest
    • elbows
    • buttocks
    • hips
    • knees.

  • ACeleste Cooper, Rheumatology, answered

    Fibromyalgia tender points are specific areas of tenderness located on the “Tender Point Model.”  The Model was used to screen people for research studies and was never meant to become the diagnostic tool for FM that it has become.  According to the tender point criteria one must have tenderness at 11 of 18 predetermined sites when pressed. See 

    The criticism with these criteria has been that some patients with FM and the comorbid conditions may not have 11 tender points or they have more than 18 in different areas of the body.  Newer research suggests that tender points may actually me myofascial trigger points or tenderness in the pain referral pattern of a myofascial trigger point. See

    All blogs, posts and answers are based on the work in Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection by Celeste Cooper, RN, and Jeff Miller, PhD. 2010, Vermont: Healing Arts press  are for educational purposes and not meant to replace medical advice.

    Author of Chapter Five, Living with and Coping Effectively Through Fibromyalgia: Detecting Barriers, Understanding the Clues, in Fibromyalgia Insider Secrets: 10 Top Experts, 2nd Ed. Ebook complied by Deirdre Rawlings, ND, PhD

  • AMehmet Oz, MD, Cardiology (Cardiovascular Disease), answered
    The 18 fibromyalgia tender points form a constellation around the neck, shoulder, chest, hips, knees and elbows. They are often in the same place as myofascial trigger points, firm nodules that often feel tight in your muscles. If you feel pain when light pressure is applied to pressure points on both the left and right side of your body (not just one side), and below and above the waist, such as around your knees as well as your neck and shoulders. Pain at 11 or more pressure points is a good indication of fibro, but you can have pain in fewer pressure points and still have fibro.
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  • AJacob Teitelbaum, Integrative Medicine, answered

    These tender points were arbitrarily chosen from dozens that are present for purposes of making the diagnosis and half are on the right and half are on the left side of the body. Fortunately, the new diagnostic criteria are eliminating the need for the tender point exam as most physicians are simply not trained in this. More importantly is the question "Do you hurt all over?", this is a more pertinent hallmark for fibromyalgia.

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  • There are 18 soft tissue sites on the body called tender points that are highly sensitive to pressure in people with fibromyalgia, and much less tender in people who do not have fibromyalgia. Your doctor may use these points to diagnose this disease. They are clustered at the base of your skull and low cervical neck, on the trapezius muscles of your shoulders, and at the second ribs, lateral epicondyles, sacral area, hips, and knees.
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What are the 18 tender points used to diagnose fibromyalgia?