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Tender Point

Indications: Fibromyalgia
1. Diagnostic Criteria: 11 of 18 tender points
Arm and Shoulder Tender Points
1. Supraspinatus tendon (above medial scapular spine)
2. Two cm distal to lateral epicondyle of elbow
Chest Tender Points
1. Costochondral junction (second rib)
Leg Tender Points
1. Posterior to greater trochanteric bursa of the femur
2. Medial fat pad of the knee (proximal to joint line)
Head and Neck Tender Points
1. Suboccipital muscle insertion
2. Low cervical (anterior C5-C7 Intertransverse space)
Back Tender Points
1. Trapezius muscle (Midpoint of upper border)
Buttock Tender Points
1. Upper outer buttocks in anterior muscle fold
Control Points (Non-tender points are non-painful)
1. Mid-forehead
2. Anterior Thigh
Differential Diagnosis: Trigger Point
1. Seen in Myofascial Pain Syndrome
2. Local tenderness with taut band and twitch response
3. Trigger Points associated with referred pain
Resources
1. Tender Point Map (Fibromyalgia Support North Down)
  1. http://www.arasmus.demon.co.uk/fmsnd/points.htm
References
1. Klippel (1997) Primer Rheumatic Disease, p.124-127

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.