Cortisone vs. PRP: The Quick Fix, the Expensive Fix, or the Right Fix?
By Mark C. Engasser, MD — Board-Certified Orthopedic Surgeon
Spend enough time around a pickleball court and you'll eventually hear someone say, "I had a cortisone shot and was playing again three days later."
Someone else will tell you, "Forget cortisone. PRP is the future. It actually heals the tissue!"
And, of course, there's always the player who has tried both, bought three knee braces, and still blames the paddle.
So what's the difference between cortisone and platelet-rich plasma (PRP)? Which works better? And is the more expensive treatment actually worth the money?
The answer depends on what you're treating, where you're injecting, and what you're hoping to accomplish.
Cortisone: The Established Anti-Inflammatory
Cortisone injections use corticosteroid medications, such as triamcinolone or methylprednisolone, to reduce inflammation and pain.
They're commonly used for arthritis, bursitis, and selected tendon-sheath disorders.
Their greatest advantage is relatively rapid symptom relief, often beginning within several days and sometimes lasting weeks or months.
But here's the important distinction:
Cortisone reduces inflammation and pain. It does not repair damaged cartilage or restore a torn tendon.
That doesn't make it a bad treatment. Reducing pain can allow patients to participate more comfortably in rehabilitation and daily activities.
The problem arises when pain relief is mistaken for complete healing.
PRP: Using Your Own Blood
Platelet-rich plasma sounds more complicated than it really is.
A clinician draws a small amount of your blood, places it in a centrifuge, and concentrates the platelets. The resulting preparation is injected into the affected joint or tissue.
Platelets contain growth factors and signaling proteins that may influence inflammation and tissue repair.
The theory is appealing: Instead of simply suppressing inflammation, perhaps we can encourage the body's own healing response.
And in some conditions, particularly certain chronic tendon disorders and mild-to-moderate knee arthritis, studies suggest meaningful symptom improvement.
However, PRP is not a miracle treatment. Preparations vary considerably, research findings are inconsistent, and there is no convincing evidence that routine PRP injections regrow worn-out joint cartilage.
PRP is promising. It is not a guaranteed regeneration treatment.
Which Injection Is Better for Which Condition?
- Cortisone
- Useful short-term pain relief
- PRP
- May help selected patients, especially with mild-to-moderate arthritis; evidence and guidelines differ
- Cortisone
- May relieve pain briefly, but recurrence and poorer longer-term outcomes are concerns
- PRP
- A reasonable option in selected chronic, persistent cases; research remains mixed
- Cortisone
- Sometimes provides temporary relief
- PRP
- Less convincing evidence than for tennis elbow
- Cortisone
- Well-established treatment
- PRP
- Insufficient evidence for routine use
- Cortisone
- Often effective, especially with splinting
- PRP
- Not routinely recommended
- Cortisone
- May provide short-term relief in selected patients
- PRP
- Routine use not supported by current orthopedic guidelines
- Cortisone
- Generally avoid injection into the tendon because of rupture risk
- PRP
- Not reliably superior to structured rehabilitation
- Cortisone
- May temporarily reduce symptoms
- PRP
- Unlikely to restore severely damaged cartilage or eliminate the need for joint replacement
| Condition | Cortisone | PRP |
|---|---|---|
| Knee osteoarthritis | Useful short-term pain relief | May help selected patients, especially with mild-to-moderate arthritis; evidence and guidelines differ |
| Tennis elbow | May relieve pain briefly, but recurrence and poorer longer-term outcomes are concerns | A reasonable option in selected chronic, persistent cases; research remains mixed |
| Golfer's elbow | Sometimes provides temporary relief | Less convincing evidence than for tennis elbow |
| Trigger finger | Well-established treatment | Insufficient evidence for routine use |
| De Quervain's tenosynovitis | Often effective, especially with splinting | Not routinely recommended |
| Rotator cuff tendinopathy | May provide short-term relief in selected patients | Routine use not supported by current orthopedic guidelines |
| Achilles tendinopathy | Generally avoid injection into the tendon because of rupture risk | Not reliably superior to structured rehabilitation |
| Advanced arthritis | May temporarily reduce symptoms | Unlikely to restore severely damaged cartilage or eliminate the need for joint replacement |
These distinctions matter. A treatment that works well for an inflamed tendon sheath may be inappropriate for a degenerative tendon.
What About Tendon Rupture?
This is one of the most important safety issues.
Corticosteroids can weaken tendon tissue, particularly with repeated injections or when injected directly into a tendon.
That risk is especially concerning around the Achilles, patellar, biceps, and rotator cuff tendons.
A tendon-sheath injection for trigger finger or De Quervain's is different from injecting corticosteroid directly into a structurally compromised tendon.
Placement matters. Diagnosis matters. Repeated injections matter.
A tendon rupture is uncommon, but it is a potentially serious complication.
PRP does not have the same established steroid-related tendon-weakening concern. However, it can cause temporary pain and inflammation, and it still carries the small risks associated with injections, including infection or injury to surrounding structures.
Neither treatment should be viewed as completely risk-free.
What About Other Side Effects?
Cortisone injections can occasionally produce temporary elevations in blood glucose, particularly in people with diabetes.
Other possible effects include post-injection pain, skin discoloration, localized fat atrophy, infection, and potential cartilage damage with repeated joint injections.
PRP usually has fewer medication-related systemic effects because it comes from the patient's own blood. However, discomfort after injection may last several days, and improvement—when it occurs—may take weeks.
Importantly, PRP preparations are not standardized. Two clinics offering PRP may be injecting substantially different products.
Let's Talk About Cost
Here's where the difference becomes particularly noticeable.
Cortisone injections: Often covered by Medicare and private insurance when medically indicated, although deductibles, copayments, facility charges, and imaging guidance can affect the final bill.
PRP injections: Frequently paid for out of pocket. Prices commonly run several hundred dollars per treatment and can reach $1,000 or more. A treatment series may cost approximately $2,000, depending on the clinic and protocol.
And paying more doesn't necessarily mean receiving a better result.
Before purchasing PRP, ask how many injections are recommended, the total cost, what preparation is being used, and what evidence supports its use for your particular diagnosis.
Don't Forget Rehabilitation
Neither cortisone nor PRP replaces a good rehabilitation program.
For many chronic tendon conditions, progressive strengthening, appropriate loading, technique modification, and time remain the foundation of treatment.
Injections may help selected patients, but they should complement a sensible treatment plan rather than substitute for one.
Dr. Engasser's Perspective
After years in orthopedic surgery, I've learned that patients understandably want two things: less pain and a quick return to their favorite activities.
Cortisone can be very effective when used appropriately. PRP has legitimate potential in selected conditions, but its benefits are not universal, and its price can be substantial.
I would be particularly cautious about repeated steroid injections around vulnerable tendons, and equally cautious about anyone promising that PRP will regenerate your worn-out knee cartilage.
My advice: Treat the diagnosis, not the marketing.
And before spending $1,500 on an injection, make sure you've considered the less glamorous treatments—rehabilitation, strengthening, activity modification, and occasionally taking a few days off pickleball.
I realize that last recommendation may be the hardest one of all.
This article is for general educational purposes and does not replace individualized medical evaluation or treatment.