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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.
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.
These trigger points are:
• front and back of neck
• mid to upper back of the shoulders
• upper chest
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.
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.
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.