Location of the 18 tender points

Occiput: on both sides (bilateral), at the sub-occipital muscle insertions.
Low Cervical: bilateral, at the anterior aspects of the inter-transverse spaces.
Lateral Epicondyle: bilateral, 2 cm distal to the epicondyles
Knee: bilateral, at the medial fat pad proximal to the joint line.
Second Rib: bilateral, at the second costochondral junction, just lateral to the junctions on upper surfaces.
Trapezius: bilateral, at the midpoint of the upper border of the muscle.
Supraspinatus: bilateral, at origins, above the spine of the scapula (shoulder blade) near the medial border
Gluteal: bilateral, in upper outer quadrants of buttocks in anterior fold of muscle.
Greater Trochanter: bilateral, posterior to the trochanteric prominence.

In everyday language, this is what we mean when we talk about the 18 points.

Do you have pain in the following pairs of points (left and right side):

1. neck: just above the collarbone and on either sideof your larynx

2. chest: a few inches below your collabone

3: elbows: on the forearm below the elbow crease and towards the outer side of your arm

4: knees: hurts on the insode of each knee pad

5: back of neck: at the base of the skull and your neck

6: shoulders: pain that is halfway between the edge of each shoulder and the bottom of your neck

7: upper back: pain where the back muscles join with the shoulder blades

8: lower back: at the top of the buttocks

9: hips: pain near the buttocks wheere muscles join your thigh

Why 11 Points out of 18?

If you have pain in in 11 of these 18 places, you could be diagnosed with FMS. Some experts believe that a person does not need to have the required 11 tender points to be diagnosed and treated for fibromyalgia. This criterion was originally intended for research purposes.

A diagnosis of fibromyalgia may still be made if a person has less than the 11 of the required tender points so long as they have widespread pain and many of the common symptoms and associated syndromes connected to fibromyalgia, such as sleep disorders and irritable bowel syndrome.

If a patient has some symptoms but does not meet the tender point criterion, a diagnosis of "possible fibromyalgia syndrome" may be assigned. You should also remember that self-diagnosis is not advised and that you should consult a skilled medical professional to conduct a thorough examination.

What Goes with Fibromyalgia?

Commonly associated symptoms of fibromyalgia include: 

Fibromyalgia Doctors

If your doctor is not familiar with fibromyalgia, the best thing to do is look for a local fibromyalgia support group meeting and ask for recommendations. This way, you’ll not only get a personal recommendation from someone who has a first-hand understanding of your issues, but it will enable you to meet others who share your concerns.

Table of Contents
1. Diagnose Fibromyalgia
2. Are these spots painful?
3. Tender points
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