PRP vs. Cortisone for Tennis Elbow — What the Evidence Shows

How They Work — Fundamentally Different

Cortisone (corticosteroid) injection suppresses the inflammatory response at the injection site. Works quickly — most patients feel relief within 3–7 days. However, tennis elbow is fundamentally a degenerative condition (tendinosis), not an acute inflammatory one. Cortisone addresses the symptom (pain) without addressing the underlying degenerative collagen disorganization.

PRP (platelet-rich plasma) delivers a concentrated dose of your own growth factors — PDGF, TGF-β, VEGF, IGF-1 — directly into the degenerated tendon tissue under ultrasound guidance. These growth factors initiate new collagen synthesis and tendon remodeling. It works more slowly than cortisone but targets the actual pathology.

What the Evidence Shows

• At 4–6 weeks: Cortisone wins. Faster, more complete pain relief short-term. PRP patients may have a 48–72 hour post-injection flare before improvement begins.
• At 3 months: Roughly equivalent outcomes. Cortisone effect begins to wane; PRP benefit continues building.
• At 6 months: PRP produces significantly better outcomes. Cortisone patients often see symptoms return; PRP patients continue improving.
• At 12 months: PRP is clearly superior. Cortisone outcomes at 12 months are often worse than physical therapy alone (Coombes et al., Lancet 2013). PRP patients have substantially lower pain and better function.

When Cortisone Is Still Appropriate

• Acute severe flare — when pain is so severe that starting physical therapy is impossible, a single cortisone injection can break the pain cycle
• Short-term event-related relief — if a patient needs temporary relief for a specific event and understands the long-term tradeoffs

What Dr. Chambers does not recommend: multiple repeated cortisone injections. Each injection slightly weakens the tendon. Three or more cortisone injections in the same tendon is associated with significantly worse long-term outcomes.

PRP Practical Considerations

• Timeline: PRP takes 6–12 weeks to produce significant improvement. Patients must commit to the longer timeline.
• Post-injection protocol: Avoid NSAIDs (ibuprofen, naproxen) for 2 weeks after injection — they blunt the inflammatory healing response that PRP initiates.
• Insurance coverage: PRP is typically not covered by insurance for musculoskeletal conditions.
• Number of injections: Usually one, with a possible second at 6–8 weeks for severe or chronic cases.

The Bottom Line

For acute severe pain, a single cortisone injection is reasonable as a bridge to physical therapy. For chronic tennis elbow lasting more than 3 months, PRP combined with eccentric physical therapy gives the best outcomes at 12 months — and is the treatment Dr. Chambers recommends for most of his tennis elbow and pickleball elbow patients.