Where are the 18 fibromyalgia tender points located?

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 on the back. They occur symmetrically down the body. On the front of the body they are located at the bottom of the neck just above the collarbone, just below the center of each collarbone, on the crease inside each elbow, and lastly on the inside of each knee. On the back of the body they are located at the bottom of the neck, above each shoulder blade, just inside each shoulder blade, at the top of the butt on either side of the lower spine, and lastly just underneath the butt on the outer part of each hamstring.
Dr. Michael Roizen, MD
Internal Medicine
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.
Jacob Teitelbaum
Integrative Medicine

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.

These trigger points are:
• front and back of neck
• mid to upper back of the shoulders
• upper chest
• elbows
• buttocks
• hips
• knees.
Dr. Mehmet Oz, MD
Cardiology (Cardiovascular Disease)
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.
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.
Fibromyalgia tender points are often, but not always, paired (the same on both sides of the body). The American College of Rheumatology has identified nine pairs of tender points that commonly occur in people with fibromyalgia. These pairs are located on both the right and left sides of the body and may affect the neck, shoulders, chest, elbows, waist, hips, and knees. No one knows why these tender points are often paired. A doctor may diagnose fibromyalgia in people who do not have these paired tender points.

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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.