What are tender points?

Dr. Mehmet Oz, MD
Cardiology (Cardiovascular Disease)
The 18 tender points were developed by the American College of Rheumatology (ACR) 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 ACR 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.
Dr. Michael Roizen, MD
Internal Medicine
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.
According to the traditional definition of fibromyalgia, there are 18 tender points on the body. These places are especially sensitive to touch. For people with fibromyalgia, these tender points can be much more sensitive to pain.
 The locations of your tender points range from the neck to the knees. You have two tender points in each of these areas:
  • front sides of neck
  • upper chest
  • outer elbows
  • inner knees
  • back part of head or skull
  • top of shoulders
  • between the shoulder blades
  • upper hips
  • outer hips
If you are especially sensitive in 11 of the 18 tender points, you may have fibromyalgia. Talk with your doctor about any pain or discomfort you feel at your tender points.
A newer set of diagnostic criteria uses a questionnaire to assess the severity of symptoms including pain, fatigue and memory problems.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.