Platelets or Steroids for a Stubborn Tendon

What are the two injections actually doing?

They are built on opposite theories of what is wrong. A cortisone shot places a corticosteroid at the sore tendon to suppress inflammation and quiet pain. A platelet injection draws your own blood, spins it in a centrifuge to concentrate the platelet fraction, and puts that back into the tendon on the theory that the growth factors platelets carry will prompt repair.

Tendinopathy is the clinical name for a tendon that has turned painful and intolerant of load, and it is usually the word on the referral slip when either needle is offered. Tendon trouble of this kind belongs to the overuse family — the injuries that accumulate through repeated demand rather than arriving in one bad moment 1Ref 1National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) (2023).Sports Injuries.Lay-education framing that tendon problems of this kind belong to the overuse family of musculoskeletal injuries, which accumulate through repeated demand rather than a single acute event..

The difference between the two theories matters more than it sounds. Quieting a pain signal and repairing a tissue are different jobs. A treatment can do the first well and nothing for the second, and the trial evidence below shows it can do the first well while the second quietly goes the wrong way.

What does the cortisone evidence show for a tendon?

For one tendon it has been tested against a dummy injection, and the result was not what anyone expected. In a randomized trial of adults with tennis elbow, a corticosteroid injection produced worse outcomes at one year and higher recurrence than a placebo injection; adding physiotherapy made no significant difference at the one-year mark either 2Ref 2Coombes BK, Bisset L, Brooks P, Khan A, Vicenzino B (2013).Effect of Corticosteroid Injection, Physiotherapy, or Both on Clinical Outcomes in Patients With Unilateral Lateral Epicondylalgia: A Randomized Controlled Trial.For tennis elbow, corticosteroid injection produced worse outcomes and higher recurrence at one year than placebo injection, and physiotherapy added no significant benefit at one year — the article's central cited fact, and its worked example of why follow-up length decides what a trial means..

The shot worked. That is the uncomfortable part. Steroid injections are not offered because nothing happens. Something does happen, and it happens fast. What the trial found is that the early relief did not survive to a year, and that the people who got the steroid ended up worse off at a year than the people who got a needle full of nothing 2Ref 2Coombes BK, Bisset L, Brooks P, Khan A, Vicenzino B (2013).Effect of Corticosteroid Injection, Physiotherapy, or Both on Clinical Outcomes in Patients With Unilateral Lateral Epicondylalgia: A Randomized Controlled Trial.For tennis elbow, corticosteroid injection produced worse outcomes and higher recurrence at one year than placebo injection, and physiotherapy added no significant benefit at one year — the article's central cited fact, and its worked example of why follow-up length decides what a trial means..

Two honest limits sit on that finding. It is one tendon — the lateral elbow — and tendons are not a category that behaves uniformly; what a steroid does at the elbow is not automatically what it does at the Achilles or the shoulder. And worse at a year is a group average, not a prophecy about any single person.

Does the picture improve with more shots?

Not in the joint where that question was tested head-on. Adults with knee osteoarthritis were randomized to an intra-articular triamcinolone injection or saline every twelve weeks for two years. The steroid group's pain was no better than the saline group's, and their cartilage volume loss was greater 3Ref 3McAlindon TE, LaValley MP, Harvey WF, et al. (2017).Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial.Repeated intra-articular triamcinolone every 12 weeks for two years gave no pain benefit over saline and was associated with greater cartilage volume loss — the basis for the article's account of why repeat-injection limits are a serious question, and its example of symptom and structure moving independently.. More injections bought no more relief, and the structural ledger moved the wrong way.

That trial is about a joint, not a tendon, and the distinction is real: a knee's cartilage and an Achilles' collagen are different tissues with different problems. But it is where most of the caution you will hear about corticosteroid cartilage harm comes from, and it is why how many cortisone shots are safe is a serious clinical question rather than a formality. When a clinician declines to keep injecting, this is the shape of the evidence behind the refusal.

It also explains something about the arithmetic of relief. If each shot buys a shrinking window and the windows do not add up to a repair, then a plan built on repeat injections is a plan that runs out.

How to read a platelet trial

This page will not hand you a verdict on platelet-rich plasma. Gale cites only sources it has checked, and the platelet-specific trials are not among the sources behind this page — so a confident answer in either direction would be an answer with nothing under it. What it can give you is the method for reading those trials when you meet them.

• Was there a saline or sham arm? A needle, a consultation, a few weeks of taking it easy, and the natural arc of a flare all produce improvement on their own. Without a dummy-injection arm, a trial cannot separate the platelets from everything else in the room.
• How long was the follow-up? The tennis-elbow trial is the standing warning: the steroid group looked good early and lost to the placebo group by a year 2Ref 2Coombes BK, Bisset L, Brooks P, Khan A, Vicenzino B (2013).Effect of Corticosteroid Injection, Physiotherapy, or Both on Clinical Outcomes in Patients With Unilateral Lateral Epicondylalgia: A Randomized Controlled Trial.For tennis elbow, corticosteroid injection produced worse outcomes and higher recurrence at one year than placebo injection, and physiotherapy added no significant benefit at one year — the article's central cited fact, and its worked example of why follow-up length decides what a trial means.. A twelve-week result is a twelve-week result and nothing more.
• What was the comparator? Beating nothing is a low bar. Beating a supervised loading program is the comparison that matters, because that program is the alternative you would actually be choosing against.
• Did the result clear a threshold a person would feel? A statistically significant difference and a difference you would notice in your day are two different claims, and trials report the first far more often than the second.

One more thing is worth knowing before a deposit clears: there is no single substance called PRP. Preparations differ in how concentrated the platelets are, in whether white cells are kept or removed, and in how the tendon is injected — so trials of PRP are not all trials of the same thing, and reading them as one body of evidence flattens a real difference. The trial-by-trial work is its own undertaking; the PRP RCT summary and the narrower question of prp for tendinopathy each have a page of their own.

The treatment with a settled verdict

Loading the tendon. For midportion Achilles tendinopathy, the physical-therapy clinical practice guideline grades the evidence for mechanical loading — eccentric work, or heavy slow resistance — as strong, for reducing pain and improving function 4Ref 4Martin RL, Chimenti R, Cuddeford T, et al. (2018).Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2018.Strong evidence supports mechanical loading via eccentric or heavy-slow-resistance exercise to reduce pain and improve function in midportion Achilles tendinopathy — the article's claim that loading carries the strongest evidence grade among its sources.. Strong is the top of that guideline's ladder, and it lands on the least marketable item on the whole menu: weeks of deliberate, slightly uncomfortable, unglamorous work.

That guideline covers the Achilles specifically, and reading it as a law of all tendons would be exactly the error this page is arguing against. Other tendons have their own guidelines and their own grades. What the Achilles evidence does establish is that the unglamorous option is not the consolation prize in this comparison — it is the item carrying the strongest grade behind it 4Ref 4Martin RL, Chimenti R, Cuddeford T, et al. (2018).Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2018.Strong evidence supports mechanical loading via eccentric or heavy-slow-resistance exercise to reduce pain and improve function in midportion Achilles tendinopathy — the article's claim that loading carries the strongest evidence grade among its sources..

A needle changes what a tendon feels. Loading changes what a tendon can do. The two are not competing for the same job, which is why framing this as platelets versus cortisone is slightly wrong from the start. A more useful conversation with a clinician is less which injection and more: what is the loading plan, and is there anything a needle needs to buy in order to make it possible?

When is a cortisone shot the right call?

When it buys something specific. Guideline panels do endorse corticosteroid injections, and they are exact about the terms. The OARSI guideline for knee, hip, and polyarticular osteoarthritis recommends intra-articular corticosteroid conditionally, and for short-term relief 5Ref 5Bannuru RR, Osani MC, Vaysbrot EE, et al. (2019).OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.Intra-articular corticosteroid is conditionally recommended for short-term relief, while education and structured land-based exercise (with weight management for the knee) are the core treatments — the article's account of the narrow terms on which a guideline endorses a steroid injection.. Conditional and short-term are not throwaway words. They describe a shot as a window, not a repair.

The same guideline names education and structured land-based exercise as the core treatment for those joints, with weight management added for the knee 5Ref 5Bannuru RR, Osani MC, Vaysbrot EE, et al. (2019).OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.Intra-articular corticosteroid is conditionally recommended for short-term relief, while education and structured land-based exercise (with weight management for the knee) are the core treatments — the article's account of the narrow terms on which a guideline endorses a steroid injection.. Read the two together and the needle's role becomes legible: it is there to make the core treatment possible, not to stand in for it. A shot that lets someone sleep, or tolerate the first three weeks of a loading program, has done a real job.

Carpal tunnel syndrome shows the same sequence written out in full. The AAOS guideline supports splinting and corticosteroid injection as nonsurgical management, and supports surgical release for appropriate patients 6Ref 6American Academy of Orthopaedic Surgeons (AAOS) (2016).Management of Carpal Tunnel Syndrome — Evidence-Based Clinical Practice Guideline.The AAOS guideline supports splinting and corticosteroid injection for nonsurgical management of carpal tunnel syndrome and supports surgical release for appropriate patients — the article's worked example of a guideline stating a full sequence of care rather than opposing an intervention.. Carpal tunnel is a compressed nerve rather than a tendon, and what is being borrowed here is the structure of the recommendation, not the diagnosis: try the conservative thing, use the injection where it earns its place, and operate when the problem persists in someone the operation fits.

Nothing on this page is an argument against needles, or against surgery. It is an argument about their place in the order. The parallel question at the hip — whether a hip cortisone injection earns its place there — carries its own trial evidence and its own page.

What to ask before paying cash for either

Four questions, and none of them are about platelets. What is the loading plan, who is supervising it, and how long has it genuinely been running? What is this injection supposed to buy — relief for a defined window, or repair? What happens if it does nothing: is there a second shot, a third, and on what evidence? And what is the total price, including the visits, either way?

That last one is worth pressing on. Cortisone injection cost and prp injection cost are each their own question, with their own page in this library, and the answers are better had in hand before the decision than discovered after it.

One framing is worth carrying into the room. The question is not which injection wins. It is what this tendon is being asked to do between now and three months from now, and whether anything needs to be bought to make that possible.