From The Manual Tender Point Survey booklet
Jointly sponsored with the University of Pittsburgh School of Medicine and the Center for Continuing Education in the Health Sciences:
Written by J. David Sinclair, MD; Terence W. Starz, MD; Dennis C. Turk, PhD
Widespread musculoskeletal pain has long plagued humankind. It made its appearance in past epochs as lumbago, muscular rheumatism, and fibrositis. Most recently, the condition has been labeled as fibromyalgia (FM).
Although the etiology and pathophysiology of FM are widely debated, the clinical entity described as FM is estimated to affect from three to six million people in the United States. Historically, there has been great variability in the criteria used for diagnosing FM. The American College of Rheumatology (ACR) conducted a multicenter study published in 1990 that specified two primary criteria that characterized FM: (1) three or more months of widespread pain defined as pain present above and below the waist on the right and left of the body and along the midline and (2) report of pain at a minimum of 11/18 specified locations (tender points – TPs) throughout the body when palpated with 4 kilograms of digital pressure. These two criteria were selected from a number of variables examined as they were shown to reliably discriminate FM from other musculoskeletal disorders in the multicenter study.
TPs are widely distributed throughout the musculoskeletal system. They are typically located in muscle bodies, over tendinous insertions and at bony prominences. The anatomic and physiologic mechanisms accounting for the presence of TPs have received great attention but explanation for their origin remains unclear.
A number of factors may influence the sensitivity of TPs during an examination: (1) the amount of force applied at the survey site, (2) the number of times (single versus repeated) and method (finger pad, dolorimeter) by which the force is applied, (3) the patient’s position which affects muscle tone and survey site localization. The sequence of site examination may influence the patient’s response based on the anchoring effect of sensations experienced at prior survey sites. A standardized examination procedure enhances the reliability of survey site reporting, interobserver reproducibility, the comparability of research studies and the direction of treatment modalities.
The Manual Tender Point Survey (MTPS) outlined in this booklet and the accompanying video describes a technique requiring approximately 5-10 minutes to perform. It is based on the 1990 American College of Rheumatology tender point protocol for FM. This booklet will (1) describe the pressure application technique, (2) discuss the precise identification of survey sites, and (3) review the complete Manual Tender Point Survey examination including the standardized examination procedure and patient instructions.
