Fig. 121.2 Location of nine bilateral (18) tender point sites for the American College of Rheumatology criteria for the classification of fibromyalgia. 1, Suboccipital muscle insertions; 2, cervical, at the anterior aspects of the intertransverse spaces at C5 to C7; 3, trapezius, at the midpoint of the upper border; 4, supraspinatus, at the origin, above the scapular spine near the medial border; 5, second rib, at the costochondral junction; 6, lateral epicondyle, 2 cm distal to the epicondyle; 7, gluteal, in the upper outer quadrant of the buttock; 8, greater trochanter, just posterior to the trochanteric prominence; 9, knee, at the medial fat pad proximal to the joint line.