What are Tender Points?

Mature woman holding knee in house
BSIP/UIG/Getty Images

Tender points can easily be confused with trigger points, but actually are phenomena (or lesions) in their own right. Tender points are present in patients who have fibromyalgia.

Tender points, as the name implies, are places on muscles that when touched with enough pressure, elicit a feeling of sensitivity in the location of the point. Tender points do not send pain anywhere else in the body; their pain is confined to the tender point itself.

They are usually no bigger than 1 centimeter.

Tender points are an identifying feature of fibromyalgia, (aka widespread pain). Neither the context in which tender points are found, nor any symptom that may accompany them contributes to the meaning of this term -- they are just places in muscles that are tender to the touch.

But when you have at least 11 out of 18 preidentified tender points (9 pairs, on either side of the body) along with the experience of chronic widespread pain, the American College of Rheumatology calls this fibromyalgia. Your medical provider will test the tender points by applying pressure to the 18 predefined locations. The amount of pressure she uses is specific and can be measured with a tool designed for that purpose, or can be estimated -- when her fingernails turn white, approximately 4 kg/cm of pressure has been applied, the amount necessary for an accurate diagnosis of a fibromyalgia tender point.

The pressure is applied gradually to both right and left sides of the body in potential tender point regions. The examiner might also test non-predefined locations for comparison.

Tender points and fibromyalgia are different than myofascial pain syndrome. Myofascial pain syndrome is characterized by, among other things, the presence of trigger points, which have different signs and symptoms than tender points.

Unlike myofascial pain syndrome, fibromyalgia, or chronic widespread pain, is not confined to a specific location or region of the body. Generally, it is pain found in all 4 limbs and in the trunk. However, people with fibromyalgia often have myofascial pain syndrome and/or trigger points, as well.

Sources:

Rachlin, E. Myofascial Pain and Fibromyalgia: Trigger Point Management. Mosby-Year Book. 1994. St. Louis.

Wolfe, F., et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia (embedded pdf). Report of the Multicenter Criteria Committee.

Coster, L, et. Al. Chronic widespread musculoskeletal pain – A comparison of those who meet criteria for fibromyalgia and those who do not. Eur J Pain. Nov 14 2007.

Continue Reading