Fibromyalgia Trigger / Tender Points

Most patients complain of a wide spread pain that affects nearly the whole of the body. This pain maybe felt throughout the body but is particular in certain areas like the back or neck.

The pain may be felt as a dull ache, a sharp shooting pain or as a burning sensation over the skin. Many patients with fibromyalgia typically express certain tender or trigger points that are maximally painful.

Recognized pain points

There are 18 recognized pain points or tender points. For a diagnosis of fibromyalgia to be made, at least 11 out of these 18 have to be painful when the doctor touches or presses upon the. These points include:-

1. Occiput or the back prominence of the head (2 points). There are muscle attachments at the back of the head. Two of these points may be tender.
2. Low cervical (2 points) these are present at the front of transverse processes of the 5th and 7th cervical vertebrae in the neck.
3. Trapezius muscle (2 points) – these are present at the midpoint of the upper border of the shoulder muscles
4. Supraspinatus muscle (2 points) – the point is present over the scapular spine near its central portion
5. Second rib (2 points) – these are beside the junctions of the ribs to the breast bone or the costochondral junctions, on the upper rib surfaces
6. Lateral epicondyle (2 points) – these are located near the elbows where the brachioradialis muscle is attached to the bone
7. Gluteal muscles (2 points) -  these points are located in the upper and inner edges of the buttocks in the front folds of the muscle
8. Greater trochanter (2 points) – these points are behind the trochanteric prominence at the hips.
9. Knees (2 points) - these points lie at the inner side of the knee at the fat pad that lies over the joint line.

Tender points and fibromyalgia diagnosis

Due to the disputes regarding the risk of faking the points as well as due to the discrepancies and non-uniformity in methods of palpating or examining the tender points the new criteria for diagnosing fibromyalgia excludes the mandatory presence of tender point positivity in presence of other symptoms conducive for diagnosis.