Muscles


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	The muscular view below, highlights the 18 Tender Points, as set forth by the American College of Rheumatology. In order for a patient to have a diagnosis of fibromyalgia, constant pain must be present, and 11, of the 18 must be tender to pressure.




	Fibromyalgia Tender Points (18)
	Pain must be present on palpation with a 4 kg force in 11 of the following 18 sites (nine bilateral sites, for a total of 18 sites): It is approximately the same amount of pressure when you press your thumbnail, until it turns white.


	Muscles Affected

	Low cervical: at the anterior aspect of the interspaces between the transverse processes of C5-C7. Trapezius: at the midpoint of the upper border. Second rib: just lateral to the second costochondral junctions. Knee: at the medial fat pad proximal to the joint line. Occiput: at the insertions of one or more of the following muscles: trapezius, sternocleidomastoid, splenius capitus, semispinalis capitus. Supraspinatus: above the scapular spine near the medial border. Lateral epicondyle: 2 cm distal to the lateral epicondyle. Gluteal: at the upper outer quadrant of the buttocks at the anterior edge of the gluteus maximus muscle. Greater trochanter: posterior to the greater trochanteric prominence.

	Lay Terms

	Lay Terms: Attachment of neck muscles at the base of the skull * Midway between neck and shoulder * Muscle over upper inner shoulder blade * 2 cms below side bone at elbow * upper outer buttock * Hip bone Just above knee on inside Lower neck in front *Edge of upper breast bone