Diagnosis

Diagnosing Fibromyalgia Syndrome

There are 18 tender points that doctors look for in making a Fibromyalgia diagnosis (see Figure 1). According to the ACR requirements, a patient must have 11 of the 18 to be considered as having Fibromyalgia. Approximately four kilograms of pressure (or about 9 lbs.) must be applied to a tender point, and the patient must indicate that the tender point locations are painful.

As the ACR criteria suggest, a Fibromyalgia diagnosis requires the "hands-on" evaluation of a patient by a medical professional skilled in Fibromyalgia diagnosis. Since patients are not always aware of the specific anatomical origins of pain in their bodies, self-diagnosis is not advised.

Because routine laboratory and x-ray testing is usually normal in Fibromyalgia patients, a complete medical history and physical exam by a physician are also crucial for a correct diagnosis. Since the symptoms of Fibromyalgia mimic several other diseases (for example, systemic lupus, polymyalgia rheumatica, myositis/polymyositis, the nerve damage of diabetes, thyroid disease, rheumatoid arthritis, multiple sclerosis, and others), it is necessary to rule out those conditions before an FMS diagnosis is made.

While a FMS diagnosis does not preclude the co-existence of another condition, one needs to be sure that no other condition is mistaken for Fibromyalgia syndrome so that proper treatment can be initiated.

The Fibromyalgia tender points

To qualify for a diagnosis of Fibromyalgia,
patients must ache all over and have tenderness
in at least 11 of these 18
spots when 4 kgs. of pressure are applied.

Location of FMS tender points:

Figure 1.

Bilateral FMS Tender Points
As Defined by the ACR9

Occiput:	Located at the sub-occipital muscle insertions.
Low Cervical:	The anterior aspects of the intertransverse spaces at C5-C7.
Trapezius:	Located at the midpoint of the upper border.
Supraspinatus:	Located at origins, above the scapula spine near the medial border.
Second Rib:	The second costochondral junctions, just lateral to the junctions on upper surfaces.
Lateral Epicondyle:	2 cm. distal to the epicondyles.
Gluteal:	Located in upper outer quadrants of buttocks in anterior fold of muscle.
Greater Trochanter:	The posterior to the trochanteric prominence.
Knee:	Located at the medial fat pad proximal to the joint line.

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