PRP vs. Cortisone (Steroid) Injections: How Do You Choose?

One of the most common questions we hear in our clinic is:

“Should I get a cortisone injection or PRP?”

The answer depends on your diagnosis, your goals, and how quickly you need relief.

Both platelet-rich plasma (PRP) and corticosteroid (cortisone) injections can play an important role in treating musculoskeletal pain. The key is understanding when each treatment is most appropriate.

When a Cortisone Injection May Be the Better Choice

If your primary goal is rapid pain relief, a cortisone injection is often the best option. Many patients experience significant improvement within just a few days.

We commonly recommend cortisone injections for:

• Acute shoulder pain related to rotator cuff inflammation

• Calcific tendinitis

• Frozen shoulder (adhesive capsulitis)

• Painful, swollen arthritic joints

• Advanced osteoarthritis when surgery is not yet desired

• Situations where patients need to feel better quickly before an important trip, family event, athletic competition, or work obligation

Benefits of Cortisone

• Fast pain relief

• Reduced inflammation

• Improved sleep

• Better mobility

• Faster return to daily activities

The Downside

While cortisone can be extremely effective, we generally recommend using these injections sparingly.

Repeated steroid injections may contribute to:

• Cartilage degeneration

• Tendon weakening

• Soft tissue damage

Short-term side effects may include:

• Sleep disturbance

• Temporary elevation of blood sugar

• Increased blood pressure

• Fluid retention

• Facial flushing

• Mood changes

For these reasons, our philosophy is simple:

Use cortisone when it’s truly needed—but make the injections few and far between whenever possible.

When PRP Is Often the Better Choice

PRP is designed with a different goal in mind.

Rather than simply reducing inflammation for a short period of time, PRP aims to support the body’s natural healing response using a concentration of your own platelets and growth factors.

For many chronic conditions, especially those involving early degeneration or tendon injury, PRP often provides more durable improvement.

PRP may be an excellent option for:

• Mild to moderate knee arthritis

• Hip arthritis

• Shoulder arthritis

• Rotator cuff tendinopathy

• Tennis elbow

• Golfer’s elbow

• Achilles tendinopathy

• Plantar fasciitis

• Many chronic tendon injuries that have failed conservative treatment

Potential Advantages of PRP

• Gradual reduction in pain

• Improved function

• Longer-lasting symptom relief than steroids in many tendon conditions

• No exposure to corticosteroid-related side effects

• Uses your own blood rather than medication

Growing research suggests PRP may help slow symptoms associated with early osteoarthritis and may outperform steroid injections for several chronic tendon disorders. Results vary by condition and by individual patient, but appropriately selected patients often experience meaningful improvements.

Why Technique Matters

Not all PRP treatments are the same.

Successful outcomes depend on several important factors:

• Drawing the appropriate amount of blood

• Using a high-quality processing system

• Preparing the correct concentration of platelets

• Precise ultrasound-guided injection

• Selecting the right patient

• Following customized pre- and post-procedure instructions

Attention to these details can significantly influence results.

At our practice, we’ve been performing ultrasound-guided PRP procedures for more than a decade and have seen many patients return to activities they thought they might never enjoy again.

Why Doesn’t Insurance Cover PRP?

This is one of the questions we hear most often.

The honest answer is: we don’t know exactly why.

Although the scientific evidence supporting PRP continues to grow, insurance coverage has not kept pace. Coverage decisions are made by insurance companies using many factors—including cost, policy decisions, and varying interpretations of the medical literature—not solely by physicians caring for patients.

Ultimately, treatment decisions should be based on:

• Your diagnosis

• The available medical evidence

• Your goals

• A thoughtful discussion between you and your physician

Insurance coverage is one factor—but it shouldn’t always be the deciding factor.

So Which Injection Is Right for You?

Cortisone may be best if you:

• Need relief within days

• Have significant inflammation

• Need to improve quickly for work, travel, or an important event

• Understand that the benefit may be temporary

PRP may be best if you:

• Want a longer-term treatment strategy

• Have chronic tendon pain

• Have mild to moderate arthritis

• Prefer to avoid repeated steroid injections

• Are looking for a treatment that supports healing rather than simply masking symptoms

Our Philosophy

There is no “one-size-fits-all” injection.

Sometimes cortisone is exactly the right treatment. Other times, PRP offers a better long-term solution. Occasionally, the best answer is neither injection at all.

Our goal is to help you make the decision that’s right for your condition, your lifestyle, and your long-term health.

If you’re dealing with joint pain, tendon injuries, or arthritis, we’d be honored to help you explore your options. Together, we’ll develop a personalized treatment plan focused on reducing pain, restoring function, and helping you stay active for years to come.

F. Clarke Holmes, M.D.