Fibromyalgia is an evolving condition in which symptoms overlap with a variety of other medical conditions. Although diagnostic criteria have been updated in attempt to more accurately and objectively identify patients with fibromyalgia, diagnosis often remains a challenge for healthcare providers.This case illustrates the utility of guidelines in combination with clinical judgment in the diagnosis and treatment approach for patients presenting with widespread pain. Although the presence of joint pain is not considered "typical" for fibromyalgia, the patient's symptoms satisfied the original diagnostic criteria published by the American College of Rheumatology in 1990, as well as the considerably different updated criteria published in 2010. Of particular importance is the understanding that fibromyalgia is not fully understood as a disease entity. With growing research, the definition of fibromyalgia continues to expand. With this in mind, patients presenting with seemingly atypical pain presentations should not be excluded from the diagnosis of fibromyalgia without further evaluation.