Tender Point

Aka: Tender Point

1. See Also
   1. Fibromyalgia
   2. ACR Fibromyalgia Diagnostic Criteria
2. Background
   1. Replaced by the ACR Fibromyalgia Diagnostic Criteria (ACRFDC) in 2010 for Fibromyalgia Diagnosis
3. Indications: Fibromyalgia
   1. Diagnostic Criteria: 11 of 18 Tender Points
4. Signs
   1. Arm and Shoulder Tender Points
      1. Supraspinatus tendon (above medial Scapular spine)
      2. Two cm distal to lateral epicondyle of elbow
   2. Chest Tender Points
      1. Costochondral junction (second rib)
   3. Leg Tender Points
      1. Posterior to greater trochanteric bursa of the femur
      2. Medial fat pad of the knee (proximal to joint line)
   4. Head and Neck Tender Points
      1. Suboccipital muscle insertion
      2. Low cervical (anterior C5-C7 Intertransverse space)
   5. Back Tender Points
      1. Trapezius muscle (Midpoint of upper border)
   6. Buttock Tender Points
      1. Upper outer buttocks in anterior muscle fold
   7. Control Points (Non-Tender Points are non-painful)
      1. Mid-forehead
      2. Anterior Thigh
5. 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
6. Resources
   1. Tender Point Map (Fibromyalgia Support North Down)
      1. http://www.arasmus.demon.co.uk/fmsnd/points.htm
7. References
   1. Klippel (1997) Primer Rheumatic Disease, p.124-127