Tenderness Folly, The

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(Author’s term.)

This is a false assumption that is often made by examiners during the physical examination of the patient. If occurs when the examiner pushes the skin lying over a soft tissue or muscle of the patient who then indicates that they found it painful. Next the examiner assumes that the pain must be due to tenderness in the underlying muscle. This is not necessarily true.

The folly became apparent from the following experience in examining a severe fibromyalgia patient.

Prior to examining her 18 tender points with a Fischer (mechanical) algometer, the author, in accordance with his usual examining procedure, tested various control points. This included pinching the first web space of each hand between the tip of the device and one of my fingertips. This tested her skin and subcutaneous tissue but not muscle as there is no muscle in this web spaces. The patient was unusually tender in these web spaces.

A few minutes later, I tested her trapezius tender points. As expected, pressing down on the skin over this tender point revealed a very low-pressure pain threshold of less than 1 kg. of force. However, this time I took the unusual step of then pinching a fold of skin over the tender point. It was unusually tender. It was clear that the tenderness of her skin overlying the trapezius was a major cause for being tender, in this location for this patient. (In my experience, many fibromyalgia patients have little, if any, skinfold tenderness; hence, the findings in this woman are not generalizable to all fibromyalgia patients.)