How is the manual tender-point survey (MTPS) performed in the physical exam for fibromyalgia?

Updated: Nov 14, 2018
  • Author: Chad S Boomershine, MD, PhD, CPI, CPT; Chief Editor: Herbert S Diamond, MD  more...
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Answer

Eighteen tender points are palpated at standard locations arranged symmetrically on the body, along with 3 control points. See the image below.

Tender points in fibromyalgia. Tender points in fibromyalgia.

The thumb pad of the examiner's dominant hand is used to apply pressure to each evaluation site one at a time during the tender-point examination. This allows the examiner to use important tactile cues and is as reliable as the use of a dolorimeter (see Pressure algometry).

The procedure is as follows: First, visually locate the evaluation site. Then, with the thumb pad, press perpendicularly into the evaluation site with gradually increased pressure for 4 seconds until a pressure of 4 kg is reached, roughly enough force to blanch the examiner's nail bed. Each tender-point site should be palpated only once to avoid sensitization. The patient is asked to respond with a "yes" or "no" if he or she has pain at the site being examined. If the patient's response is "yes," the individual is asked to rate the pain on a scale of 0 (no pain) to 10 (worst pain), and record each response. A pain severity score of at least 2 is required to count a tender point as positive.


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