The "Tender Points" of Fibromyalgia

  • Specific Points of Pain
    Fibromyalgia can cause pain that echoes throughout your body. But many people with the condition feel pain most acutely at 18 specific “tender points.” When your doctor evaluates you for fibromyalgia, he or she may put pressure on these points. In fact, until recently, being diagnosed with fibromyalgia required documenting tenderness on examination in at least 11 of the 18 points.

  • Know the Warning Signs
    Scientists now know it’s possible to have fibromyalgia without pain at these points, and they’re no longer necessary to diagnose the condition. However, pain at these sites is still a warning sign. The tender points come in pairs that usually affect both sides of your body, four on the front of your body and five on the back.

  • Tender Points 1 and 2: Left and Right Low Neck (Cervical Area)
    The term “cervical” refers to your neck. You may feel pain on the front of your neck, between your fifth and seventh cervical vertebrae (spine bones).

  • Tender Points 3 and 4: Left and Right Upper Chest (Second Rib)
    As the name implies, these points rest along the second rib from the top. They’re on the front of your chest on either side of your sternum, just below your collarbone.

  • Tender Points 5 and 6: Left and Right Elbows (Lateral Epicondyle Area)
    If you’re standing with your hands by your side, these points will also be on the front side of your body. They’re in your outer elbow, just below the crease that forms when you bend your arms.

  • Tender Points 7 and 8: Left and Right Knees
    These points are on the inside of your knees, in the fatty padding that aligns with your joint.

  • Tender Points 9 and 10: Posterior Left and Right Neck (Occiput Area)
    These points are behind your ear, where your neck meets the base of your skull on the back of your head.

  • Tender Points 11 and 12: Left and Right Trapezius
    Your trapezius muscles stretch between your neck and shoulders on the back of your body. These pain points might occur anywhere along the upper borders of these muscles.

  • Tender Points 13 and 14: Left and Right Shoulder Blades (Supraspinatus Area)
    Also on the back of your body, you may feel discomfort along your shoulder blades.

  • Tender Points 15 and 16: Left and Right Hips (Greater Trochanter Area)
    Pain may focus in the side of your hip, where you feel the bony prominence near the top of each thigh.

  • Tender Points 17 and 18: Left and Right Gluteal
    You may feel tenderness on the outer, upper portion of your buttocks.

  • New Ways to Diagnose Fibromyalgia
    In 2010, the American College of Rheumatology changed the way doctors diagnose fibromyalgia. Now, instead of using the tender points exclusively, your doctor will ask questions about your pain—including how severe it is and how long it lasts—along with checking for symptoms like fatigue, depression, and headaches. However, many people with fibromyalgia do feel pain in these points, which may help nail down the diagnosis. Tell your doctor if you’re experiencing tenderness along with overall pain and fatigue.

The Tender Points of Fibromyalgia
  1. Fibromyalgia. Centers for Disease Control and Prevention. http://www.cdc.gov/arthritis/basics/fibromyalgia.htm 
  2. Questions and Answers about Fibromyalgia. National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/Health_Info/Fibromyalgia/default.asp  
  3. Fibromyalgia. National Library of Medicine. http://www.nlm.nih.gov/medlineplus/ency/article/000427.htm 
  4. Fibromyalgia. National Library of Medicine. http://www.nlm.nih.gov/medlineplus/ency/imagepages/9758.htm 
  5. Fibromyalgia. American College of Rheumatology. http://www.rheumatology.org/Practice/Clinical/Patients/Diseases_And_Conditions/Fibromyalgia/  
  6. Fibromyalgia Fact Sheet. Office on Women's Health. http://www.womenshealth.gov/publications/our-publications/fact-sheet/fibromyalgia.cfm
  7. Wolfe F and Häuser W. Fibromyalgia diagnosis and diagnostic criteria. Ann Med. 2011;43(7):495-502.
  8. Brummett CM and Clauw DJ. Fibromyalgia: a primer for the anesthesia community. Curr Opin in Anaesthesiol. 2011;25(5):532-539.
  9. Wolfe F. How to use the new American College of Rheumatology fibromyalgia diagnostic criteria. Arthritis Care & Res. 2011;63(7):1073–4.
  10. Wolfe F et al. The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity. Arthritis Care & Res. 2010;62(5):600–610.
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Last Review Date: 2019 Sep 10
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