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Tender Points

The Copenhagen official Fibromyalgia Syndrome definition states that you must have at least 11 out of 18 specified tender points to qualify for entry into a clinical study of FMS. Tender points hurt where pressed, but do not refer pain elsewhere -- that is, pressing a tender point does not cause pain in some other part of the body.(Note that when examining yourself for tender points, you must use enough pressure to whiten the thumbnail.)

The official definition for patients to be admitted to a clincal study on FMS further requires that tender points must be present in all four quadrants of the body -- that is, the upper right and left and lower right and left parts of your body. Furthermore, you must have had widespread, more-or-less continuous pain for at least three months.

Tender points occur in pairs on various parts of the body. Because they occur in pairs, the pain is usually distributed equally on both sides of the body.

On your back, they are present in the following places:
Along the spine in the neck, where the head and neck meet on the upper line of the shoulder,
A little less than halfway from the shoulder to the neck three finger widths, on a diagonal, inward from the last points
On the back fairly close to the "dimples" above the buttocks, a little less than halfway in toward the spine.
Below the buttocks , very close to the outside edge of the thigh, about three finger widths.

On the front of your body, tender points are present in the following places:
On the neck, just above inner edge of the collarbone.
Still on the neck, a little further out from the last points, about four finger widths down.
On the inner (palm) side of the lower arm, about three finger widths below the elbow crease..
On the inner side of the knee, in the "fat pad".

The tender point locations are not "written in stone." They can vary from person to person, which can cause further problems with diagnosis. In traumatic FMS, for example, tender points are often clustered around an injury instead of, or in addition to, the 18 "official" points. These clusters can also occur around a repetitive strain or a degenerative and/or inflammatory problem, such as arthritis.

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Date of Last Update: 07/27/12