Treating Lateral Epicondylitis: Is PRP Better Than Cortisone?

Lateral epicondylitis, commonly known as tennis elbow, is an overuse injury of the tendons attaching to the outside of the elbow. If you've tried rest, ice, physical therapy or nonsteroidal anti-inflammatories (NSAIDs) with only partial relief, you may be weighing two advanced injection options: cortisone or platelet-rich plasma (PRP). In this article, we'll explain how each works, review the evidence, and help you decide whether PRP for tennis elbow could be a better fit for your recovery.

What Is Lateral Epicondylitis?

• Tendon microtears caused by repetitive gripping or wrist extension
• Pain and tenderness on the outer elbow that may radiate into the forearm
• Stiffness or weakness when lifting, gripping or shaking hands
• Symptoms that develop gradually, often worsening over weeks to months

Most people improve with a combination of rest, bracing, targeted exercises and NSAIDs. However, up to 10% of cases become chronic, prompting consideration of injections or surgery.

Cortisone Injections: Pros and Cons

Corticosteroid (cortisone) injections have long been used to ease pain and reduce inflammation.

Pros:

• Rapid pain relief (often within days)
• Widely available and typically lower cost
• Can be done in a doctor's office

Cons:

• Relief may be temporary (weeks to a few months)
• Repeated injections risk tendon weakening or rupture
• May mask pain, potentially delaying proper rehabilitation
• Some studies show higher recurrence rates compared to other treatments

A 2013 meta-analysis in the American Journal of Sports Medicine found that while cortisone provides quicker short-term relief than placebo, benefits often fade by 12 weeks, and recurrence is common.

PRP Therapy: How It Works

PRP involves drawing a small sample of your blood, spinning it in a centrifuge to concentrate platelets, then injecting that platelet-rich plasma into the injured tendon. Platelets release growth factors thought to:

• Stimulate collagen production
• Promote new blood vessel formation
• Enhance natural tendon healing

PRP is considered a "biologic" treatment, using your own cells rather than steroids or medications.

Comparing PRP vs Cortisone for Tennis Elbow

Factor	Cortisone	PRP
Onset of Relief	Days	Weeks (often 4–6 weeks)
Duration of Effect	Short term (4–12 weeks)	Longer term (6–12 months reported)
Healing Mechanism	Anti-inflammatory	Regenerative
Risks	Tendon weakening, skin changes	Mild soreness at injection site
Number of Injections	Often 1–2	Typically 1–3, spaced 3–4 weeks apart
Cost	$100–$300 per injection	$500–$2,000 per session (varies)

Efficacy

• A 2019 randomized trial in the Journal of Shoulder and Elbow Surgery showed similar pain relief at 3 months between cortisone and PRP, but PRP outperformed cortisone at 12 months.
• A 2021 review in the British Journal of Sports Medicine found moderate evidence that PRP provides longer-lasting benefits than cortisone for chronic tennis elbow.

Side Effects and Safety

• Cortisone: rare but serious risk of tendon rupture, skin discoloration, local fat atrophy.
• PRP: transient pain or stiffness post-injection, low risk of infection since it uses your own blood.

Cost and Accessibility

• Cortisone is low-cost and covered by most insurance plans.
• PRP is often considered "out-of-pocket," with higher upfront costs but potential for fewer repeat treatments.

Who Might Benefit Most from PRP?

PRP for tennis elbow may be a good option if you:

• Have chronic symptoms lasting 6 months or longer despite conservative care
• Wish to avoid corticosteroids or have had limited relief from them
• Prefer a treatment aimed at tendon healing rather than just pain relief
• Are healthy enough to tolerate minor injection discomfort
• Understand the higher cost and longer onset of pain relief

Patients with active infections, blood disorders, or on blood thinners may not be good candidates for PRP.

Practical Steps and Expectations

1. Consultation
   Speak with a sports medicine specialist, orthopedic surgeon or pain management physician to evaluate your history, exam findings and imaging (if needed).

2. Injection Procedure

   • Performed under ultrasound guidance for accuracy
   • Procedure time: 20–30 minutes
   • Mild local anesthetic may be used

3. Post-Injection Care

   • Rest the arm for 48 hours
   • Gradual return to light activities over 1–2 weeks
   • Begin or continue a structured physical therapy program focusing on eccentric strengthening and flexibility

4. Follow-Up

   • Assess pain and function at 4–6 weeks
   • Decide on additional PRP sessions if needed (usually up to 3 total)

When to Seek Professional Advice

If your're experiencing persistent elbow pain or other concerning symptoms and want to understand what might be causing them before your appointment, use Ubie's free AI symptom checker to get personalized insights in just a few minutes and help determine whether you need urgent care or can wait for a scheduled consultation.

Seek immediate evaluation if your elbow pain is severe, worsening at rest, or accompanied by:

• Numbness or tingling in your fingers
• Significant swelling or redness
• Fever or signs of infection
• Inability to bend or straighten the elbow

Conclusion

Both cortisone and PRP injections have a place in treating chronic tennis elbow. Cortisone offers quick relief but may not last, while PRP for tennis elbow aims to promote true tendon healing with more durable benefits. Your choice will depend on:

• Severity and duration of symptoms
• Previous treatments tried
• Budget and insurance coverage
• Personal preference for biologic versus steroid therapy

Always discuss injection risks and benefits with your healthcare provider. And remember, if you experience any symptoms that could signal a serious condition, speak to a doctor right away.