Signs Displayed in FMS

Widespread pain and tenderness are the most general and common symptoms in Fibromyalgia Syndrome. People who suffer from FMS describe both dull, enduring pain as well as acute, excruciating pain. Neurological dysfunction in both the Central Nervous System (CNS) and the Peripheral Nervous Systems (PNS) are largely responsible for the painful experience of affected persons. What is most interesting about FMS patients, however, is that they experience characteristic tenderness in reproducible, specific, and localized anatomic places. Palpation of a tender point elicits severe and widespread pain surrounding the specific anatomic location. This phenomenon has granted physicians the ability to diagnose FMS with some degree of certainty. There are approximately 18 specified tender points exhibited in patients with FMS. Patients who report at least 11 of these 18 tender points are usually diagnosed with FMS. The first step in FMS diagnosis, however, is to rule out a host of other associative disorders that can display symptoms similar to those of FMS. Some of these disorders are hypercalcemia, Paget's Disease, polymyositis, parathyroid disease, metastatic cancer, myofascial pain syndrome. Once disorders such as these are ruled out and tender points are identified, then an FMS diagnosis is usually made. FMS patients usually also experience significant fatigue, difficulty sleeping (deep sleep deficiency), irritable bowel syndrome, and sometimes associative depression and/or anxiety.

Bilateral FMS Tender Points
As Defined by the ACR⁹

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

Note: Graphic Courtesy of Daniel Clauw, M.D.