PRP vs Corticosteroid Injection For Tendonitis - Which One Should I Choose?
In today’s healthcare, most of us have heard the terms “PRP” or “steroid injection” as a medical treatment option for an inflamed tendon. There are a ton of research studies on the effectiveness of these treatment options. There are so many studies that comprehensive academic reviews of these studies have been published. Well now, published in the International Journal of Sports Physical Therapy, a massive review study of these reviews has been done! The article, “Platelet-Rich Plasma versus Corticosteroid Injection for the Treatment of Lateral Epicondylitis: A Systematic Review of Systematic Reviews” by Kempt, et al. was done with the purpose to synthesize the current evidence on the efficacy of platelet rich plasma (PRP) injections versus corticosteroid (CS) injections as treatment interventions for lateral epicondylitis (tennis elbow). (1)
Tendonitis - caused by repetitive motions that result in microtrauma to the tendon after which there is a failure of the repair mechanism
Tennis elbow
Formally known as lateral epicondylitis (or epicondylalgia), tennis elbow is a pathology affecting the common extensor tendon of the wrist and hand muscles that originate on the lateral epicondyle of the elbow. The term epicondylalgia is slowly replacing the term epicondylitis as this pathology is rarely an acute inflammation. It is rather a degenerative “wear-and-tear” pathology that develops over time. The term “tendinosis” is more appropriate as well. In fact, there is evidence that this injury happens due to an insufficient amount of inflammatory cells in the injured tendon tissue!(4) Inflammatory cells are necessary to promote the healing process of the microtrauma that occurs during activities involving repetitive movements. Epicondylaglia is a blanket term to mean “-having pain in the epicondyle” and therefore covers both acute and chronic pathologies.
It earns the name “tennis elbow” because the muscles and tendons affected are used during the repetitive motions of swinging a racket during tennis. The most common muscle effected is the extensor carpi radials brevis due to its poor blood supply making it susceptible to tissue degeneration without proper healing.(2) Rotator cuff pathologies are a common risk factor for developing tennis elbow.(3) It’s not uncommon as a physical therapist to help patients with rotator cuff injuries and later help the same patient with tennis elbow.
Corticosteroid vs PRP
It’s first important to understand what a PRP injection is. PRP is an acronym for platelet-rich plasma. The injection utilizes the patient’s own blood with a high concentration of platelets and growth factors. These growth factors promote tissue repair, blood supply, and regeneration of injured tissue.(6) PRP injections are delivered through three different strategies: (1) injected into the most injured and degraded tissue, (2) injected into multiple sites around the target tissue, and (3) into the area of most tenderness. As of now, there is no optimal strategy and all three seem to be effective equally.
PRP is the optimal treatment option for long-term (>8 weeks) effectiveness in decreasing pain and improving function. (1,5,6)
Corticosteroid (CS) injections seem to be more applicable for short term outcomes (2-8 weeks) when treating inflammatory conditions such as arthritis, bursitis, and tendonitis. Although the effects last longer, the pain relief from a PRP injection is as quickly compared to a CS injection. CS injections are useful when fast-acting relief is needed and the pathology may resolve under 8 weeks. It is important to note that some suggest CS injections can negatively affect the long-term healing process and even compromise the tensile properties of the tendon.(1,5)
Struggling with elbow pain or tendonitis? Want to maximize your health and compete better in your sport? Book a session with our sports physical therapist or sports performance coach today!
If you’ve had an injury and are in need of a return to play program, schedule a physical therapy session with us to get back to your sport. Get back in the game ready to meet your sport specific demands.
References
Kemp JA, Olson MA, Tao MA, Burcal CJ. Platelet-Rich Plasma versus Corticosteroid Injection for the Treatment of Lateral Epicondylitis: A Systematic Review of Systematic Reviews. IJSPT. 2021;16(3):597-605.
Vaquero-Picado A, Barco R, Antuña SA. Lateral epicondylitis of the elbow. EFORT Open Rev. 2016;1(11):391-397.
Lai WC, Erickson BJ, Mlynarek RA, Wang D. Chronic lateral epicondylitis: Challenges and solutions. Open Access J Sports Med. 2018;9(243):243-251.
Arirachakaran A, Sukthuayat A, Sisayanarane T, Laoratanavoraphong S, Kanchanatawan W, Kongtharvonskul J. Platelet-rich plasma versus autologous blood versus steroid injection in lateral epicondylitis: Systematic review and network meta-analysis. J Orthop Traumatol. 2016;17(2):101-112.
Ben-Nafa W, Munro W. The effect of corticosteroid versus platelet-rich plasma injection therapies for the management of lateral epicondylitis: A systematic review. SICOT-J. 2018;4:11.
Tang S, Wang X, Wu P, et al. Platelet‐rich plasma vs autologous blood vs corticosteroid injections in the treatment of lateral epicondylitis: A systematic review, pairwise and network meta‐analysis of randomized controlled trials. PMR. 2020;12(4):397-409.
Disclaimer: This SciSport blog post is a summary of an article printed in an academic research journal. The purpose of this blog post is to provide readers with academic and educational content in an easy-to-understand format. We take no credit for the material and knowledge presented, and we encourage readers to take a look at the original source provided in the References section.
