Fibromyalgia: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

• General physical examination – including blood pressure, pulse, body weight, height; further:
  • Inspection (viewing).
    • Palpation (palpation) of tender points (pressure painful points) with a pressure of about 4 kiloponds (the thumbnail shows paling in the distal area) – especially at the muscle insertions at the back of the head, at the elbow and at the inside of the knee, according to the ACR criteria* [burning, gnawing pain aggravated by specific stimuli, such as cold, damp weather, stress, physical overexertion, anxiety, lack of sleep].
    • Skin (normal: intact; abrasions/wounds, redness, hematomas (bruises), scars) and mucous membranes.
    • Gait (fluid, limping).
    • Body or joint posture (upright, bent, gentle posture).
    • Malpositions (deformities, contractures, shortenings).
    • Muscle atrophies (side comparison!, if necessary circumference measurements).
    • Joint (abrasions/wounds, swelling (tumor), redness (rubor), hyperthermia (calor); injury indications such as hematoma formation, arthritic joint lumpiness, leg axis assessment).
    • Inspection and palpation of the thyroid gland [due topossible cause: hypothyroidism (hypothyroidism)].
    • Extremities [swelling sensation in the hands]
  • Palpation of vertebral bodies, tendons, ligaments; musculature (tone, tenderness, contractures of paraverebral musculature); soft tissue swelling; tenderness (localization! ; restricted mobility (spinal movement restrictions); “tapping signs” (testing painfulness of spinous processes, transverse processes, and costotransverse joints (vertebral-rib joints) and back muscles); illiosacral joints (sacroiliac joint) (pressure and tapping pain? ; compression pain, anterior, lateral or saggital; hyper- or hypomobility?
  • Palpation of prominent bone points, tendons, ligaments; musculature; joint (joint effusion? ); soft tissue swelling; tenderness (localization!).
  • Measurement of joint mobility and range of motion of the joint (according to the neutral zero method: the range of motion is given as the maximum deflection of the joint from the neutral position in angular degrees, where the neutral position is designated as 0°. The starting position is the “neutral position”: the person stands upright with the arms hanging down and relaxed, the thumbs pointing forward and the feet parallel. The adjacent angles are defined as the zero position. Standard is that the value away from the body is given first). Comparative measurements with the contralateral joint (side comparison) can reveal even small lateral differences.
  • If necessary, special functional tests depending on the affected joint.
  • Assessment of blood flow, motor function and sensitivity:
    • Circulation (palpation of pulses).
    • Motor function: testing of gross strength in lateral comparison.
    • Sensibility (neurological examination)
• Further orthopedic examinations wg : differential diagnoses:
  • Collagenoses (group of connective tissue diseases caused by autoimmune processes) – systemic lupus erythematosus (SLE), polymyositis (PM) or dermatomyositis (DM), Sjögren’s syndrome (Sj), scleroderma (SSc) and Sharp syndrome (“mixed connective tissue disease”, MCTD).
  • Myopathies (muscle diseases, inflammatory, metabolic, endocrine).
  • Myalgia (muscle pain, toxic, in CNS and peripheral nervous system damage).
  • Osteoporosis (bone loss)
  • Polymyalgia rheumatica – disease from the rheumatic forms

  If necessary, gynecological examination [due topossible accompanying symptom: dysmenorrhea (period pain)].

• If necessary, neurological examination [due topossible accompanying symptoms:
  • Paresthesias (sensory disturbances) in the hands and feet.
  • Vertigo (dizziness)
  • Tension headache]

  [due todifferential diagnosis:

  • Multiple Sclerosis (MS)]
• If necessary, psychiatric examination [due topossible accompanying symptoms:
  • Anxiety (anxiety disorders)
  • Depression
  • Cognitive disorders, such as concentration disorders or short-term memory disorders
  • Sleep disturbances (insomnia) resulting in non-restorative sleep (→ fatigue)]
• [due todifferential diagnoses:
  • Chronic fatigue syndrome (CFS).
  • Depression
  • Restless legs syndrome (restless legs syndrome).
  • Sleep apnea – breathing pauses during sleep leading to fatigue during the day to sudden falling asleep.
  • Sjögren’s syndrome (group of sicca syndromes) – autoimmune disease from the group of collagenoses, which leads to a chronic inflammatory disease of the exocrine glands, most often the salivary and lacrimal glands; typical sequelae or complications of sicca syndrome are:
    • Keratoconjunctivitis sicca (dry eye syndrome) due to lack of wetting of the cornea and conjunctiva with tear fluid.
    • Increased susceptibility to caries due to xerostomia (dry mouth) due to decreased salivary secretion.
    • Rhinitis sicca (dry nasal mucous membranes), hoarseness and chronic cough irritation, and impaired sexual function due to disruption of mucous gland production of the respiratory tract and genital organs]
• [due topossible secondary disease: depression]
• Health check

Square brackets [ ] indicate possible pathological (pathological) physical findings. * The American College of Rheumatology (ACR) classifies chronic pain in multiple body regions (English : chronic widespread pain [CWP]) as follows:

• > 3 months of existing pain in:
  • Axial skeleton (cervical spine or anterior thoracic spine or thoracic spine or lumbar spine); and
  • Right half of the body and left half of the body and
  • Above the waist and below the waist

Criteria for the clinical diagnosis of FMS (AWMF guideline FMS).