Diagnosing fibromyalgia isn’t easy. There are no blood tests or X-ray tests for diagnosing fibromyalgia. Tests are done to exclude other possible diagnoses. Therefore, the diagnosis of fibromyalgia is made purely on clinical grounds based on the doctor’s history and physical examination. Many Doctors use a tender points scale developed by the American Academy of Rheumatologists (AAR) many years ago. Pain feels different to different people. It is easy to say, my body hurts and then the Doctor doesn’t have much to go off of. That is why doctors often check for certain tender points on the body to help diagnose fibro. The 18  tender points (9 pairs) are usually painful when pressed, and can spread pain to other body parts.

The 18 tender points or trigger points used to diagnose fibromyalgia are scattered all over the body. Tender points are found on the neck, shoulder blades, lower back, elbows, buttocks, knees, and other areas. These tender points are quite small, but a good doctor knows how to locate them. During the examination, the doctor will use control points to test to make sure you do not react to the nontender points. If you do, the diagnosis may not be fibromyalgia. To meet the diagnostic criteria for fibromyalgia, you must have pain in 11 of the 18 tender points.

Some doctors use a more informal diagnostic system that the AAR has developed, so work with your doctor if you think you may have fibromyalgia. The second diagnostic system is based on self-reported severity of symptoms.

What are tender points?

Tender points are pain points or localized areas of tenderness around joints, but not the joints themselves. These tender points hurt when pressed with a finger.

Tender points are often not deep areas of pain. Instead, they are superficial areas seemingly under the surface of the skin, such as the area over the elbow or shoulder.

The 9 Pairs of Tender Points to Diagnose Fibro

1. Back of the Neck

Tender where the base of the skull and the neck meet.

2.Front of the neck

Doctors will also check pain the front of the neck for potential fibromyalgia diagnose. Tender points are located above the collarbone, on either side of the larynx.

3. Upper Back

Tender points located where the back muscles connect to the shoulder blades in the upper back.

4. Shoulders

Tender halfway between the edge of the shoulder and the bottom of the neck.

5. Lower Back

Tender points located at the very top of the butt, right at the bottom of the lower back.

6. Chest

Tender points on either side of the sternum, a few inches below the collarbone (near the second rib).

7. Hips/Butt

Tender near where the butt muscles curve to join the thighs.

8. Knees

Tender to the touch on the inside of each knee pad

9. Elbows

Tender on the forearms, near the crease of each elbow. The pain is usually below the crease and around the outer side of the arm.

In addition to this 18 points Doctors will check the level of severity of these symptoms:

• Fatigue
• Waking unrefreshed
• Cognitive (memory or thought) problems

Plus number of other general physical symptoms

Are Tender Points The Only Way To Diagnose Fibromyalgia?

No it is not. Tender points have always been controversial, and according to a fibroaction.org  article, they are no longer required for diagnosis.

” Twenty years after the American College of Rheumatology (ACR) published its first criteria for the diagnosis of Fibromyalgia, a new criteria has been proposed as an alternative method of diagnosis.” FibroAction.org

What is the New Diagnosis Criteria?

Criteria

A patient satisfies diagnostic criteria for fibromyalgia if the following 3 conditions are met:

1. Widespread pain index (WPI)
   7 and symptom severity (SS) scale score
   5 or WPI 3–6 and SS scale score
   9.
2. Symptoms have been present at a similar level for at least 3 months.
3. The patient does not have a disorder that would otherwise explain the pain.

Wide Spread Pain Index

WPI: note the number of areas (below) in which the patient has had pain over the last week. In how many areas has the patient had pain? Score will be between 0 and 19.

Shoulder girdle, left; Hip (buttock, trochanter), left; Jaw, left; Upper back; Shoulder girdle, right; Hip (buttock, trochanter), right; Jaw, right; Lower back; Upper arm, left; Upper leg, left; Chest; Neck; Upper arm, right; Upper leg, right; Abdomen; Lower arm, left; Lower leg, left; Lower arm, right; Lower leg, right.

In Closing

I hope this provides the information you were looking for about diagnosing fibromyalgia. It’s important to find a Doctor that will listen to you and it’s important that you tell your Doctor about all your symptoms so he can help treat them. There is currently no scan, or blood test to tell you if you have fibro, so these tender points are all the Doctors have to go on. For years, many people were dismissed by doctors and told that their fibromyalgia was “all in their heads.” This attitude has changed in recent years as many in the medical community have begun to accept fibromyalgia as a real ailment, and new medications have been approved to treat its symptoms. When a doctor tests tender points for pain, he or she will also check “control” points or other non-tender points on your body to make sure you don’t react to these as well. Some physicians use a special instrument called a “doximeter” or “dolorimeter” to apply just the right amount of pressure on tender points.

Stay Strong Fibro Friends!

Sources: WebMD, WebMd, Rheumatology.org, Rheumatology.org, Fibroaction