What are the 18 tender points used to diagnose fibromyalgia?

The 18 tender points or trigger points used to diagnose fibromyalgia are scattered all over the body. Tender points are found on the neck, shoulder blades, lower back, elbows, buttocks, knees, and other areas. These tender points are quite small, but a good doctor knows how to locate them. During the examination, the doctor will use control points to test to make sure you do not react to the nontender points. If you do, the diagnosis may not be fibromyalgia. To meet the diagnostic criteria for fibromyalgia, you must have pain in 11 of the 18 tender points. 

The 18 tender points were developed by the American Academy of Rheumatology (AAR) to help identify people with fibromyalgia. These are 18 spots on the body, including the back of your head, elbows, shoulders, knees, hip joints and around your neck, that may be super sensitive if you have fibro. If you have fibromyalgia, when your doctor applies light pressure to these spots with his or her finger (just enough for the nail bed to become white), you may feel pain. But people without fibro normally wouldn't even flinch. If you have pain when your doctor touches 11 of the 18 tender points, that supports a diagnosis of fibromyalgia. You need to feel pain on both sides of the body, and above and below the waist. But even If you feel pain in fewer than 11 tender points, you may still have fibromyalgia. Some doctors use a more informal diagnostic system that the AAR has developed, so work with your doctor if you think you may have fibromyalgia. The second diagnostic system is based on self-reported severity of symptoms.

In order to be diagnosed with fibromyalgia, you must experience discomfort in at least 11 of 18 tender points designated by the American College of Rheumatology. There are 8 tender points on the front of the body and 10 and the back. They occur symmetrically down the body. On the front of the body there are 2 at the bottom of the neck just above the collarbone, 2 just below the center of each collarbone, 1 on the crease inside each elbow, and two more on the inside of each knee. On the back of the body there are 2 at the bottom of the neck, 1 above each shoulder blade and just inside each shoulder blade, 2 at the top of the butt on either side of the lower spine, and 2 more just underneath the butt on the outer part of each hamstring.

Tender points are specific areas of tenderness 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 http://www.thesethree.com/fibromyalgia/tender-points.php 

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 http://www.thesethree.com/cmp/myofascial-trigger-point.php

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. www.TheseThree.com

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

http://www.fibromyalgiainsidersecrets.com/whoarewe/Celest.html