Fibromyalgia: where are the tender points that cause pain on palpation?

By Cristiano Antonino Last updated Aug 12, 2022

Fibromyalgia is a condition characterised by widespread muscle pain associated with fatigue, stiffness, insomnia, memory problems and mood swings

Although there is no real cure for this problem, both medication and a targeted approach to relaxation and stress reduction can help alleviate the symptoms.

After ruling out other muscular, neurological or skeletal pathologies, there are two elements that, once ascertained, allow a correct diagnosis of fibromyalgia:

An accurate medical history showing that the pain is symmetrically spread and has persisted for at least 3 months.
Palpation of the 18 body points known as tender points, which in the healthy subject do not cause pain, while in the fibromyalgia sufferer no fewer than 11 are painful. The pressure to be exerted must be at least 4 kg

The tender points are located

4 in the anterior neck,
4 behind the shoulders,
2 at the height of the cerebellum (suboccipital intersection of the trapezium),
2 at elbow height,
2 at knee height,
2 above the buttocks
2 on the lower sides of the buttocks (retrotrochanteric region).

For a good diagnosis of fibromyalgia, the doctor should find at least 11 of these 18 tender points

Therefore, if fewer than 11 were found but the other criteria for fibromyalgia (widespread pain, muscle rigidity, non-restful sleep) were met, it would still be a good idea to follow a fibromyalgia therapy.

Two other tender point assessment systems have recently been compared: the myalgic and dolorometric assessment with the classic digital form.

These studies have demonstrated the greater effectiveness of the classical palpation system.

The diagnostic criterion of palpation remains the main method used.

In addition to the 18 described, there are many other tender points in individual patients.

There may also be, as with spasmophilia, positivity to peripheral muscle hyperexcitability induced by the ligature test with transient ischaemia and hyperpnoea.