Fibromyalgia diagnosis: The ACR-1990 criteria

You can find the video after the text

This is the third of three short films on the examination of fibromyalgia. If you have not seen the first films, watch them first. The first film is about excluding other underlying diseases and an in-depth anamnesis. In the second film, we go through the diagnostic criteria for fibromyalgia from 2016. Click on one of the links that appear to get to the films. In this video, we will go through the diagnostic criteria from 1990.(1)

My name is Andreas Persson and I am a physiotherapist and specialist in pain and pain rehabilitation. What I say in the film can be found in text form together with references to the scientific literature that the things I say are based on. The link is in the description.

We will go through the criteria part by part in the order in which they are set out in this form. The form can be printed from my website. The Link is in the description.

We will first go through the basic criteria and then the painful points.

The first criterion is that the affected must have had their pain for at least three months. The affected is then asked if they have pain in both the right and left side of the body, if they have pain both above and below the waist, and if they have pain in the back, neck, or front of the chest. The affected only need to have pain in one of the areas (back, neck, front of chest) for it to count. If any of the above is not met, the affected does not meet the criteria.

In addition to the basic criteria, pain testing at 18 predetermined points is part of the criteria. The points are called tender points, which are often confused with trigger points, which is something else

For the test to be more reliable, the finger that will be pressing should be calibrated. You can do this by adding a weight, for example, a dumbbell that weighs 4kg on the finger. 4 kg is about 8,8 pounds. It is with 4 kg pressure that the examiner will press on the different points. If you have placed a weight on the finger, for example, the thumb or forefinger, you know approximately how it feels when you press hard enough.(1)

When pressing on the different points, it is important not to press with 4 kg pressure immediately. You should start with lighter pressure and push harder and harder until you have reached 4 kg pressure. I think about 2 seconds is enough time to reach full pressure. If the patient expresses pain before reaching full pressure, the pressure on the point should be interrupted. The point is then judged to be painful.

Before starting to perform the tests of pain on the 18 points, it is important to tell the patient what you want to know. The patient should tell if it hurts or if it does not hurt when you are pressing. If the patient says that it hurts, the point is considered painful. If the patient says that it does not hurt, it does not count as painful. If the patient says something else like the point is a little sore, tell the patient that she must decide if it hurts or if it does not hurt.

The 18 points consist of 9 pairs where one point is in a specific place on one side of the body while the other point in the pair is in the corresponding place on the other side of the body. Eight of the points are tested in the supine position and ten of the points in the prone position. The following points are tested in supine position:

Intertransversal spaces C5-C7 from the front. This point is located in the middle of the muscle Sternocleidomasteudeus which we can see in this picture.

The next point is located on the second rib at the front of the body in the transition between the cartilage joint towards the sternum and the rib itself. You press on the upper, that is, the cranial part of the rib.

The third pair of points are located on the outside of the forearm 2 cm distal to the lateral epicondyle.

The fourth pair of points is located in the soft parts just proximal to the medial joint gap in the knee.

Next, come the points that are tested when the patient is lying in the prone position.

The fifth pair of points is located on the suboccipital muscle attachments. This point is located just caudal of the base och the skull. 

Sixth point pair. The upper edge of the trapezius muscle, in the middle of the muscle. 

Seventh point pair, Supraspinatus origin. This point is located in the medial part of the supraspinatus fossa of the shoulder blade.

Eighth point pair, Glutealt upper lateral part of the buttocks.

Ninth pair, Rear edge of trochanter major.

To meet the ACR-1990 criteria for fibromyalgia, all the basic criteria must be met and it must hurt when pressing on at least 11 of 18 points.

Press the like button if you liked this video and check out my youtube channel for more videos about fibromyalgia and chronic pain.


1. Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum. 1990;33(2):160-72. 

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