Đầu gối: pad chất béo trung gian gần Gluteal dòng doanh: ở góc phần tư trên ngoài của mông ở cạnh trước của maximus Greater trochanter mông phía sau sự nổi bật trochanteric lớn hơn | RHEUMATOLOGY Low cervical at the anterior aspect of the interspaces between the transverse processes of C5-C7 Trapezius at the midpoint of the upper border Lateral epicondyle 2 cm distal to the lateral epicondyle Knee at the medial fat pad proximal _ to the joint line Anterior view Occiput at the insertions of one or more of the following muscles trapezius sternocleidomastoid splenius capitis semispinalis capitis Second rib just lateral to the second costochondral junctions w Gluteal at the upper outer quadrant of the buttocks at the anterior edge of the gluteus maximus Supraspinatus above the scapular spine near the medial border Greater trochanter posterior to the greater trochanteric prominence Posterior view FIGURE . The 18 tender points used in the diagnosis of fibromyalgia. Classification criteria are those of the American College of Rheumatology. Reproduced with permission from Imboden JB et al. Current Diagnosis Treatment in Rheumatology 2nd ed. New York McGraw-Hill 2006. 662 TABLE . Differential Diagnosis of Fibromyalgia Disease Category Examples Endocrine disorders Hypothyroidism 1 Addison s disease Cushing s disease hyperparathyroidism. Autoimmune disorders Polymyalgia rheumatica a RA SLE polymyositis. Medications Lipid-lowering drugs antiviral agents tapering of corticosteroids. Infection HCV a HIV parvovirus Lyme disease subacute bacterial endocarditis. Malignancy Myeloma breast lung or prostate cancer. Neurologic disorders Carpal tunnel syndrome a MS a sleep apnea a cervical Psychiatric disorders Vitamin D deficiency a Commonly encountered diagnoses. RHEUMATOLOGY Trigger-point injections and myofascial release are of uncertain benefit. Randomized controlled clinical trials of dry needling saline injections anesthetic injections botulinum toxin acupuncture and sham acupuncture as therapies have not shown significant benefit beyond nonspecific placebo-related effects. Ultrasound treatment of myofascial trigger points is no more .
