POLL: Do you have tenderness at Perrin's point on your left breast (diagnostic for ME/CFS)?

[Hip]

This is a poll for ME/CFS patients (you), and also optionally for a healthy control person (eg a healthy friend or family member) that you might like to recruit.

The polls asks whether there is soreness or tenderness when you press your fingers or thumb into Perrin's point, a spot located on your left breast around 2 to 3 cm to the left, and 2 to 3 cm above, your left nipple Ref: 1 This corresponds to a distance of around 3.5 cm from the nipple, along a diagonal line (see the diagram).

The tender area may not be exactly in the spot specified, so you may have to feel around this spot, searching for an area of tenderness.

Note that in medical terms, tenderness is where pain or discomfort appear only when an affected area is touched or pressed, and where there is no pain or discomfort when the area is not touched.

Perrin's Point is Located 2 to 3 cm to the Left,
and 2 to 3 cm Above, the Left Nipple

Note that Perrin's point corresponds to a distance of around 3.5 cm
from the nipple, along a 45 degree diagonal line (line shown in yellow)
​

When examining your Perrin's point for soreness or tenderness, a good reference for comparison is the corresponding spot on your right breast. If this spot on your right breast is not tender, but your Perrin's point is tender, then that helps confirm the Perrin's point tenderness. But I guess it is also possible that both left and right points will be tender, or that both are tender, but the left is more tender than the right.

Note that the Perrin's point is located in the third intercostal space, which is the area between the third and fourth ribs (counting from the top). So to examine Perrin's point, you want to press your finger or thumb into the flesh between your two ribs, at the given location of Perrin's point.

If you have any soreness or tenderness when gently pressing into your fingers or thumb into your flesh Perrin's point, please vote YES in this poll. If there is no tenderness at Perrin's point, please vote NO in this poll. If you tried to feel the tenderness, but don't feel confident about whether your Perrin's point is tender or not, you can vote NOT SURE (you can change your vote at any time in the future).



Optionally, for this poll you can also recruit a healthy control (eg a healthy friend or family member), and get them to test for soreness and tenderness at their Perrin's point in the same way. If they report tenderness, please answer YES in the healthy control section of this poll, answer NO if they do not report tenderness, or NOT SURE if they don't feel confident about whether their Perrin's point is tender or not.

This testing of a healthy control person is optional, and you don't have to answer this section of the poll. Or if you like, you can answer the poll for yourself (the ME/CFS patient) now, and at a later date, add an answer for the healthy control part of the poll (this poll is set up so that you can change or add to your answers at any time in the future).



Dr Raymond Perrin has found that most ME/CFS patients have tenderness at Perrin's point. An independent study confirmed this, finding that 81% of ME/CFS have tenderness at Perrin's point, but no healthy controls had this tenderness (the study tested 42 ME/CFS patients and 20 healthy controls). Thus this study concluded that as a means to diagnose ME/CFS, the Perrin's point tenderness test had a sensitivity of 81%, and a specificity of 100%.

Dr Perrin thinks that ME/CFS patients have a dysfunction of the lymph system and dysfunction of the lymph's central pump the thoracic duct, with this dysfunction arising from autonomic nervous system problems (the ANS controls the thoracic duct). Perrin thinks that as a result of the dysfunction, toxins carried by the lymph fluid are being pumped back into the breast tissue and into the brain. Ref: 1 You can see in the image above that the top of the thoracic duct routes into the top of the left breast. More info in this post.



Limitations of this poll: it is possible that detecting tenderness at Perrin's point requires appropriate training, and so is a task that cannot be given to untrained ME/CFS patients.

 

[alkt]

unfortunately many people with m.e are tender bloody every where most of my intercostal spaces are tender. so it is not really fair to say that Perrins point is any more or less tender ouch .

 

[Hip]

unfortunately many people with m.e are tender bloody every where most of my intercostal spaces are tender. so it is not really fair to say that Perrins point is any more or less tender ouch .

I've never heard that ME/CFS patients are tender everywhere. We know ME/CFS patients can have tender lymph nodes, but that does not equate to tenderness everywhere. I am certainly not tender everywhere, apart from some tender lymph nodes.

Some ME/CFS patients have pain in their muscles or joints, but pain is not the same thing as tenderness.

In fibromyalgia there are multiple tender points in the muscles (and in fact having multiple tender points is a requirement for diagnosis under the Canadian consensus criteria of fibromyalgia); but ME/CFS is not fibromyalgia.

 

[alkt]

very true about m.e .not being fibro but not everyone with m.e gets added diagnosis of fibro not a surprise when many in the medical profession prefer to bury their heads in the sand rather than admit that modern medicine is failing in regards of many complex conditions. I have had m.e for nearly 29 years and there has always been pain and sensitivity . so what is the difference between pain caused by mild pressure to an area and pain caused by an area that is tender to the touch.

 

[Murph]

Is this inspired by the perrin point study out today?

https://www.ncbi.nlm.nih.gov/pubmed/29133321

 

[Hip]

Wikipedia gives a medical definition of tenderness:

In medicine, tenderness is pain or discomfort when an affected area is touched. It should not be confused with pain. Pain is patient's perception, while tenderness is a sign that a clinician elicits.

So tenderness is where pain or discomfort appear only when an affected area is touched or pressed, and where there is no pain or discomfort when the area is not touched.

I think I will add this definition to the first post of this thread, so that we are clear on what tenderness means in the medical sense.

 

[PinkPanda]

Interesting about the dysfunction of the lymph system. I read about the function of the spleen at some point. The spleen is part of the lymph system. In western medicine the spleen is attributed some immune functions like increasing lymphocyte production, filtering old red blood cells from the blood and recycling iron from them.

In traditional chinese medicine the spleen works together with the stomach to digest foods and pull 'Qi/energy' out of them (nutrients like amino acids, lipids,..).They associate low spleen function with gut symptoms and low spleen energy can cause fatigue, possibly because of the inability to absorb nutrients from foods.

I don't think spleen function is a huge issue in ME/CFS, but I found it an interesting aspect on the side, maybe also because of the connection of digestion, energy and immune system. Warmth- not freezing, warm foods and drinks can support the spleen function, stress weakens it.

I also find the role of lymph system in energy levels interesting, because lymph fluid contains nutrients (proteins, fats) and transports them. There seems to be little attention for possible importance of the lympathetic system, although like blood, lymph fluid is one of the major fluids circulating in the body.

 

[Hip]

Is this inspired by the perrin point study out today?

https://www.ncbi.nlm.nih.gov/pubmed/29133321

Yes, there is a thread here discussing the new Perrin study.

 

[Hip]

In my case, I can feel a tender area around 3.5 cm above and 3.5 cm to the left of the center of my left nipple, and I am assuming this the tender area that Raymond Perrin is referring to, so I have voted YES.

At the corresponding point on the right breast, I have no such tenderness.

 

[pamojja]

At the corresponding point on the right breast, I have no such tenderness.

Same in my case.

 

[Scarecrow]

At the corresponding point on the right breast, I have no such tenderness.

Both sides are tender but my right is slightly more so than the actual Perrin's Point.

 

[Scarecrow]

This testing of a healthy control person is optional, and you don't have to answer this section of the poll. Or if you like, you can answer the poll for yourself (the ME/CFS patient) now, and at a later date, add an answer for the healthy control part of the poll (this poll is set up so that you can change or add to your answers at any time in the future).

Ideally, your healthy control should not be a relative.

 

[Mary]

I'm sore on both sides. It's a sharp sort of pain, like when I press certain acupressure points on the soles of my feet. I voted for the first option.

 

[Seven7]

I had my breast died in that side and yes it hurts like a mother$&@&&. What is special about that point?
Also is interesting that is the point he looks when most everybody has the pain in the third rib to the right of the left breast ( more like conchodritis). Which I forgot if it was Chaney or the other that noticed it also.

 

[pattismith]

Raymond Perrin has found that most ME/CFS patients have tenderness at Perrin's point. An independent study confirmed this, finding that 81% of ME/CFS have tenderness at Perrin's point, but no healthy controls had this tenderness (the study tested 42 ME/CFS patients and 20 healthy controls). Thus this study concluded that as a means to diagnose ME/CFS, the Perrin's point tenderness test had a sensitivity of 81%, and a specificity of 100%.

If you don't have a control group with people with other diseases (but not ME/CFS), you can't claim for a 100% specificity.
If you just need a test with 100% sensitivity and 100% specificity only to discriminate CFS/ME patients from healthy ones, just ask them how they feel.

 

[PeeWee]

Eight or ten years ago my partner's osteopath said her lymphatic system needed to drain, & that she could drain it by massaging at this point, which was tender (Perrin point). Years later, 3.5 years ago, she got cfs. She has the Perrin point tenderness today.

How can that fit with 100% of healthy controls not experiencing the tenderness. Could tenderness at the Perrin point in a healthy person be a very early indication of cfs to come?

 

[Hip]

If you don't have a control group with people with other diseases (but not ME/CFS), you can't claim for a 100% specificity.

I agree, to claim 100% specificity, you would have to examine people with diseases other than ME/CFS, to ensure that Perrin's point tenderness only occurs in ME/CFS, but not in other diseases or in healthy controls.


The question though is whether tenderness at Perrin's point has useful diagnostic power.

For example, we sometimes get people arriving at this forum listing their symptoms and asking whether we think they might have ME/CFS or not. Sometimes they have such classic ME/CFS symptoms that it seems very likely that they have this disease. At other times, it's less clearcut. In these less clearcut cases, Perrin's point tenderness might be a useful diagnostic tool.

But then Perrin's point tenderness would need to be better validated, and as you say, one would need to ensure that Perrin's point tenderness does not occur in other diseases, especially in other diseases which have similar symptoms to ME/CFS and can be mistaken for ME/CFS, such as hypothyroidism, celiac disease, anemia and systemic lupus erythematosus. It is for these diseases with similar symptoms to ME/CFS that a good differential diagnosis would be handy.

 

[Hip]

Eight or ten years ago my partner's osteopath said her lymphatic system needed to drain, & that she could drain it by massaging at this point, which was tender (Perrin point). Years later, 3.5 years ago, she got cfs. She has the Perrin point tenderness today.

How can that fit with 100% of healthy controls not experiencing the tenderness. Could tenderness at the Perrin point in a healthy person be a very early indication of cfs to come?

That's an interesting observation and question. After your partner was made aware of tenderness in the area that corresponds to Perrin's point, was your partner hit with any ME/CFS triggers (like viral infection) that could explain the later onset of ME/CFS?

The idea that tenderness at Perrin's point could presage the later onset of ME/CFS is an interesting one. I pondered on a similar question myself, regarding swollen tender lymph nodes. Tender lymph nodes (especially on the sides of neck and in the underarm area) are a characteristic symptom of ME/CFS, are listed as ME/CFS symptoms in the CDC Fukuda and CCC definitions of ME/CFS.

I had swollen tender lymph nodes (in the neck, underarms, chest and groin areas) for many years before developing ME/CFS, and I wondered whether these swollen tender lymph nodes might be a risk factor for the later development of ME/CFS.

Lymph nodes play a crucial role in the immune response, and swollen or tender lymph nodes are found in autoimmunity, so any prior abnormalities in the lymph nodes could conceivably predispose an individual to ME/CFS when they later catch a ME/CFS-associated enterovirus or herpesvirus.

I set up a poll here asking ME/CFS patients whether their swollen lymph nodes occurred before they developed ME/CFS, or only appeared afterwards. According to that poll, around a quarter of ME/CFS patients had swollen lymph nodes before they developed ME/CFS, and three-quarters of patients only got swollen lymph nodes after they were hit by ME/CFS. (The poll is slightly in error, in that I asked about swollen lymph nodes, but the ME/CFS symptom listed in the Fukuda and CCC definitions is tender lymph nodes). So that poll suggests that prior issues with swollen lymph nodes could be a risk factor for the later development of ME/CFS.

 

[PeeWee]

That's an interesting observation and question. After your partner was made aware of tenderness in the area that corresponds to Perrin's point, was your partner hit with any ME/CFS triggers (like viral infection) that could explain the later onset of ME/CFS?

Yes!

She had had Glandular fever many years ago and had swollen lymph nodes in her neck from time to time from then on.

Tenderness at the Perrin point was there 8-10 years ago.

3.5 years ago her cfs began with an illness & rash, diagnosed as shingles, followed by repeated illnesses with rashes over the next year; rashes 2-4 were also diagnosed and treated as shingles. She was prescribed Acyclovir, the shingles anti-viral, for these first 4. From the 5th rash the doctor said this couldn't be shingles, so didn't prescribe Acyclovir. Without the anti-viral the later rashes were more extensive & lasted longer. We believe there was a viral infection involved in the beginning of her illness which, whatever it was, responded to Acyclovir to some extent.

2 years ago a viral screen suggested Epstein Barr viral reactivation.

 

[Hip]

3.5 years ago her cfs began with an illness & rash, diagnosed as shingles

That sounds like she may have caught an enterovirus infection, as enterovirus often causes temporary immune suppression that allows varicella zoster (the shingles virus) to reactivate — see Dr John Chia's study here. In the UK unfortunately we don't have any means to test for chronic enterovirus infections, but in the US, ARUP Lab offers a test for this virus. Dr Chia finds oxymatrine can make major improvements to those with enterovirus-associated ME/CFS, so you might like to search for threads about oxymatrine.