The Fibromyalgia Exam

Fibromyalgia, unlike other musculoskeletal disorders, is not a pain problem that is easy to diagnose with medical imaging or blood testing. Fibromyalgia can be diagnosed only through a medical history and physical exam. Though the physical changes that cause patients to feel the pain of fibromyalgia won't present on X-Rays and MRI imaging, they can be observed by the hands on testing of patients during a physical examination. Fibromyalgia patients will feel a heightened sensitivity to certain areas of their muscles and the skin over the muscles upon touch by the doctor. One of the key determinants of a fibromyalgia diagnosis is tender points, or tender, painful areas in the muscles, tendons or places where the bone can be felt through the skin.

Many patients with fibromyalgia don't even notice these tender points until a doctors who is trained to locate and palpate then, performs a formal examination on them. Doctors who perform this examination are trained in mapping of the musculoskeletal system and the study of a system known as a fibromyalgia tender points chart. This chart is fairly consistent across most patients, including different age groups and sex. There are 18 recognized tender points in fibromyalgia. Patients who are sensitive in 11 or more of these tender points, and who have global pain in several areas of the body, are given a diagnosis of fibromyalgia. Overall, there are 9 groups of tender points with a contralateral tender point on the opposite side of the body. Contralateral means on the opposite side as another structure (Thus, the right leg is contralateral to the left leg).

Observe from the following diagram the following 18 recognized tender points in Fibromyalgia, with 10 posterior (back of body) points and 8 anterior points (front of the body). Let's take a look at these tender points, from back to front, and top to bottom.



Fibromyalgia Tender Points: General locations of the 18 tender points that make up the criteria for indentifying fibromyalgia.

Back (Posterior): There are 5 groups of contralateral tender points (for a total of 10 tender points), located from the apex of the neck to the top and lateral side of the thigh. Here are the names of these tender points.
  • Occiput: suboccipital muscle insertions. These tender points are located just below the base of the skull.
  • Trapezius: midpoint of the upper border. These are two sets of tender points located near the top of the trapezius muscle.
  • Supraspinatus: above the medial border of the scapular spine. This single set of tender points is located above the buttocks, in the middle of the back.
  • Gluteal: upper outer quadrants of buttocks.
The Fibromyalgia exam is an exam that is design to confirm the condition of Fibromyalgia as the cause of the patients muscle pain or body pain. The presence of fibromyalgia may be confirmed by the presence of tender points to specefic areas of the body.

Front (Anterior): There are 4 groups of contralateral tender points (for a total of 8 tender points), located from the base of the neck to just above the kneecap. Here are the names of these tender points.
  • Low cervical: anterior aspects of the intertransverse spaces at C5-C7.
  • Second rib: second costochondral junctions.
  • Lateral epicondyle: 2cm distal to the epicondyles.
  • Knee Medial fat pad proximal to the joint line.