Now, there is something to understand about this image and all others like it, they exist for only one reason, to help give you an idea of what doctors are supposed to be looking for, when they attempt a diagnosis of FM. As the tender points seen in FM, are one of a kind to FM.

This does Not mean however, that these are the only areas of pain with FM. This is unfortunately, a common belief that is reinforced by such images. In 1990, the primary diagnostic criteria for FM was created, as up to that point, it was done by exclusion, meaning if you ruled out everything else, then .. it was assumed to be FM. This has created a lot of problems for those of us with the disorder, for the simple fact, that it created the idea of it being a "waste basket" diagnosis. So the main line diagnostic criteria was created. The official wording is :

A. Widespread pain in all four quadrants of the body, for a minimum of three months

B. At least 11 of the 18 specified tender points

Now, what this meant, is if you didn't have at least 11 of the 18, you didn't have FM according to the criteria. Which has been proved wrong, and was proved wrong less than six years after the criteria was created. The lack of 11 out of 18, is often seen in those who do indeed have FM. This is especially true in men. ( which is yet another reason why they may be under diagnosed ) Therefore, the criteria has been expanded to include the most common signs seen with FM, which are:

Fatigue
Irritable bowel
Sleep disorders
Chronic headaches
Jaw pain ( TMJ signs or dysfunction)
Cognitive or memory impairments
Post-exertional malaise ( exhaustion )
Muscle pain
Morning stiffness (waking up stiff and in pain)
Numbness and tingling sensations (Paresthesias)
Skin and/or chemical sensitivities
Myofascial pain or CMP
Costochondritis
and others...

Mind you, these things are not FM. However they are so commonly seen in persons with FM, that if the person has several of these things going on and is positive for the tender points, and has had widespread pain for more than 3 mts, then the doctor can reasonably assume a possible diagnosis of FM, barring ruling out any other conditions, which mimic FM signs.

Now, it is important with a tender point exam, that the doctor knows how to do it correctly, as if they do not, what can happen is, they can press on CMP pain points instead, which can be anywhere ! This has caused more than one doctor to assume the person is malingering, as with CMP trigger points on site link, you could have them body wide. ( meaning it can hurt for them to poke you almost anywhere on your body )

So the problem lies, in the fact, that far too many doctors, still do not know how to do a tender point exam, properly. The problem is so large, to where there are those who are suggesting that doctors have to pass a test, to prove they know how to do it right, as part of their medical training. Article

I would whole heartedly agree, as this skill, like any other diagnostic skill requires understanding and practice to do correctly. There is very little pressure ( 4 gm ) is needed to do a proper tender point exam, and some very specific areas to press, those and NO others, are to be used for diagnostic purposes. 

They are:

- Occiput: bilateral, at the suboccipital muscle insertions ( back of your head, just under your hair line )
- Low cervical: bilateral, at the anterior aspects of the intertransverse spaces at C5-C7 ( just about directly under the frist ones, where your head meets your shoulders )
- Trapezius: bilateral, at the midpoint of the upper border ( about at the top of the deltoid muscles )
- Supraspinatus: bilateral, at origins above the scapular spine near the medial border ( where your shoulder blade is )
- Second rib: bilateral, at the second costochondral junctions, just lateral to the junctions on upper surfaces. ( under your collar bones, about half way to your breasts )
- Lateral epicondyle: bilateral, 2 cm distal to the epicondyles ( outer edge of your elbow )
- Gluteal: bilateral, in upper outer quadrants of buttocks in anterior fold of muscle ( outer top edge of your hip )
- Greater trochanter: bilateral, posterior to the trochanteric prominence ( close to the hip joint in the back )
- Knees: bilateral, at the medial fat pad proximal to the joint line ( mind you it is the fat pad of the knee, not the knee joint )

A bit of copy and paste to any search engine, will give you lots of diagrams of exactly where these points are, so you have a good understanding, for yourself, this is important. Notice, all of them are very specific as to where, and tender points, as rule, are not that large, so they have to know and understand, exactly where to press, or they are getting the wrong information.

So if your doctor is pressing anywhere else, and is supposed to be doing an tender point exam, and cannot tell you, exactly where they are supposed to be looking, it's likely you have the one of many, who does not know how to do it correctly. My personal suggestion is, stop them and ask them, what they think they are supposed to be doing, and where, and if they cannot answer you, in detail, then it's likely you need a different doctor.