Elbow pain has a way of creeping into everything. You feel it when you pour coffee, twist a doorknob, lift a suitcase, or settle into a forehand on court. In clinic, two patterns dominate: lateral epicondylitis, better known as tennis elbow, and medial epicondylitis, called golfer’s elbow. They are both overuse tendon problems, not sudden injuries. The biology inside the tendon changes over months, sometimes years. Collagen fibers fray, blood supply diminishes, and the tissue shifts from acute inflammation to a degenerative state. This is why pills and rest alone often disappoint. The tissue needs a nudge back toward healing.
Platelet rich plasma therapy, usually shortened to PRP, is one of the few options that aims at the tendon’s biology rather than simply silencing symptoms. I have treated hundreds of elbows with PRP over the past decade, and seen patterns in who responds, how to prepare, and how to avoid pitfalls. This guide gathers those lessons, translates the evidence into plain language, and answers the most common questions in a practical way.
What tennis elbow and golfer’s elbow really are
Despite the names, these conditions are not limited to athletes. Tennis elbow affects the tendons on the outside of the elbow, most frequently the extensor carpi radialis brevis. Repetitive gripping, typing, lifting a pan with the palm down, or doing pull‑ups can provoke it. Golfer’s elbow affects the inner elbow tendon complex where the wrist flexors and pronator teres attach. Hammering, throwing, heavy curls, and even aggressive yardwork can set it off.
Standard scans tell part of the story. Ultrasound often shows hypoechoic regions, tendon thickening, and sometimes small partial tears. MRI can reveal tendinosis and edema at the epicondyle, occasionally with a tiny intrasubstance tear. But the key concept is this: most chronic cases are degenerative more than inflammatory. The tissue is caught in a failed healing loop. That is where platelet therapy for healing attempts to change the trajectory.
How PRP works for tendons
PRP is made from your own blood, so it is an autologous plasma injection. We draw a small amount, usually 15 to 60 milliliters, and spin it in a centrifuge to concentrate platelets. Platelets carry growth factors and cytokines like PDGF, TGF‑β, VEGF, and IGF‑1. These signaling molecules can stimulate local cells, recruit macrophages that clear debris, and encourage collagen remodeling. The idea is not that PRP magically replaces tissue, but that it toggles the environment back toward repair.
There are flavors of PRP. Leukocyte‑poor PRP has fewer white blood cells and is gentler on tendons. Leukocyte‑rich PRP carries more inflammatory cells and may be more appropriate for some ligament injuries. For elbow tendinopathy, most clinicians favor leukocyte‑poor or balanced PRP to reduce post‑injection soreness while still delivering growth factors. Some clinics mix in local anesthetic, but I avoid it inside the tendon because it can be toxic to tenocytes, and because it dilutes the platelet concentration. A superficial anesthetic track is enough for comfort.
PRP differs from steroid injections. Cortisone can quiet pain for weeks, sometimes months, but repeated shots weaken tendon, and long‑term outcomes for chronic tennis elbow are often worse than with exercise. PRP does not numb pain right away, and in fact, soreness often increases for a few days. The upside is durability. When PRP works, the gains tend to hold.
What the evidence actually says
When you filter hype out and read the better trials and systematic reviews, a picture emerges. For lateral epicondylitis that has failed structured physical therapy and activity modification, PRP injections outperform saline and, over the medium to long term, beat corticosteroid injections on pain and function. Improvements commonly begin between four and eight weeks, with stronger changes at three to six months. Some trials report meaningful benefits out to a year or more.
Medial epicondylitis has fewer high‑quality studies, but clinical experience and smaller trials show similar, if slightly less robust, trends. The response rate is still solid, especially in people whose pain localizes clearly to the medial epicondyle and shows degenerative changes on ultrasound.
Results depend on technique, platelet concentration, and patient selection. If the injectate is too dilute, or the needle never reaches the degenerative tendon region, outcomes drop. If the patient resumes heavy gripping or pull‑ups too soon, microtrauma interrupts remodeling. The devil is in the details.
A day in clinic: what the procedure looks like
Patients always ask about the procedural flow, so here is how I handle it. We confirm the diagnosis with a careful exam and ultrasound. If you have neck pain with arm symptoms or numbness, we clear cervical radiculopathy first. If there is a full‑thickness tear, PRP alone will not fix the mechanics and surgical referral may be appropriate.
On procedure day, you hydrate, avoid NSAIDs, and eat a light meal. We draw blood, usually 30 to 60 milliliters for a single elbow. After centrifugation, we check the platelet count relative to your baseline. I prefer a 4 to 6 times baseline concentration for tendons. More is not always better, but you need to be above whole blood levels.
With you supine, we prep the skin and use ultrasound guidance. I numb the skin and subcutaneous tissue with a small wheal of anesthetic. The needle enters the degenerated zone of the common extensor or flexor tendon. A mild peppering technique creates micro‑channels without excessive trauma. We slowly inject 2 to 4 milliliters of platelet rich plasma. The entire injection takes several minutes. A compressive bandage and simple aftercare instructions finish the visit.
There is no need for sedation. The discomfort is manageable for most patients. Plan for a ride home if your dominant arm was treated and you have a long commute.
What it feels like afterward
Expect a flare. Most people report a deep ache for 24 to 72 hours, peaking in the first 48. Ice is fine in short intervals for comfort, and acetaminophen helps. I recommend skipping NSAIDs for at least a week because they blunt some of the inflammatory signaling PRP aims to harness. Gentle wrist and finger range of motion starts the same day. Avoid forceful gripping, push‑ups, pull‑ups, heavy curls, or hammering for two weeks.
By the second week, soreness settles. Light isometrics enter the plan. Eccentrics and progressive loading come later. The biggest mistake I see is rushing the return to full training when the elbow starts to feel better at week two or three. Tendon remodeling needs time. The clock is measured in weeks to months, not days.
Rehabilitation that dovetails with PRP
Rehab is not optional. PRP can change the biology, but the tendon still needs a graded mechanical signal to organize the new collagen. An experienced physical therapist will guide this. The early phase focuses on pain modulation, shoulder and scapular mechanics, and gentle isometrics at mid‑range. As pain allows, we shift to eccentrics for the wrist extensors or flexors, then to concentric‑eccentric control, then to load tolerance and endurance. Grip retraining, forearm rotation control, and proximal strength matter more than people think. Keyboard and mouse adjustments, racquet grip size, and tool ergonomics can make or break outcomes.
A typical return timeline: light daily activity by one week, structured therapy by week two, meaningful strength work at four to six weeks, sport‑specific drills by eight to ten weeks, and full return somewhere between 8 and 16 weeks depending on severity and compliance. Many notice the first clear improvement around week four. The best gains often land between weeks eight and twelve.
Who is a good candidate
PRP works best for patients with chronic, localized tendinopathy of the lateral or medial elbow that has not responded to a well‑designed therapy program, activity modification, and at least several weeks of conservative care. The exam should reproduce pain at the epicondyle with resisted wrist extension or flexion and with gripping. Ultrasound should show degenerative changes. Smokers, uncontrolled diabetics, and people on systemic steroids have lower success rates, though they can still improve.
I avoid PRP if there is a full‑thickness tendon rupture, significant elbow arthritis as the primary pain generator, active infection, severe coagulopathy, or an inability to pause blood thinners when medically safe. If you are on anticoagulants, coordination with your prescribing physician is essential. Pregnancy is not an absolute contraindication, but I typically defer elective procedures. If your pain is diffuse, neurologic, or primarily cervical, address that first.
How many sessions and how often
For elbow tendinopathy, one PRP session is often enough. In my practice, roughly 60 to 70 percent of chronic tennis elbow patients reach their goal with a single injection. Around 20 to 30 percent benefit from a second session spaced 8 to 12 weeks later if progress stalls. Third sessions are uncommon and reserved for partial responders who are improving but not satisfied. Golfer’s elbow tracks similarly, with a slight tilt toward needing a second session more often.
Spacing matters. The tendon needs time to respond. Repeating injections too soon does not help and can increase irritation.
Safety profile and side effects
Because PRP uses your own blood, allergic reactions are rare. The most common side effect is temporary pain and swelling at the injection site. Bruising is not unusual. Infection risk is low, on the order of 1 in several thousand when sterile technique is followed. Nerve irritation is rare at the elbow but possible. If you develop fever, spreading redness, or severe unrelenting pain, call your clinician.
PRP does not carry the tendon‑weakening effect seen with repeated steroid shots. It also does not have the systemic side effects of NSAIDs. That said, technique matters. Avoid practitioners who inject blind without ultrasound, who cannot describe their PRP preparation clearly, or who cannot outline a rehab plan.
PRP versus other options
People considering platelet rich plasma therapy usually weigh it against several paths. Let’s lay out the trade‑offs tightly and plainly.
- Corticosteroid injection gives quick relief for many but tends to recur and can weaken tendon if repeated. It fits acute flares that need short‑term relief and in patients who cannot commit to rehab, but is not ideal for a long‑standing tendinopathy you want to truly fix. Focused exercise therapy is the foundation. Many recover with a well‑designed eccentric and isometric program, ergonomic changes, and load management. It is low cost and low risk, but requires consistency. Needle tenotomy without PRP can disrupt degenerative tissue and stimulate bleeding to spark healing. It helps some patients and costs less than PRP, but outcomes often lag behind PRP when the same technique is used. Shockwave therapy provides mechanical signaling and can reduce pain in tendinopathy. It can pair well with rehab and sometimes with PRP. It is less invasive and a fair middle step if you are hesitant about injections. Surgery, typically debridement and repair, works for refractory cases. Success rates are high, but so are recovery time and costs. I consider it after a solid attempt at biologic and conservative care, unless there is a major tear or other compelling reason to operate.
Stem cell therapy often enters the conversation. When people say “stem cells,” they usually mean bone marrow aspirate concentrate or adipose‑derived cell preparations. For straightforward elbow tendinopathy, high‑quality evidence does not support them over PRP, and they carry higher cost and regulatory complexity. PRP vs stem cell therapy is not a close call here. PRP has more data, a cleaner safety profile, and usually better value.
Cost, value, and what to ask your provider
The cost of platelet rich plasma therapy varies widely. In the United States, expect a PRP injection cost for the elbow in the range of 500 to 1,500 dollars per session depending on geography, kit quality, whether ultrasound is included, and clinical expertise. Insurance coverage is inconsistent. Some plans cover PRP for lateral epicondylitis after conservative failure, most still do not. Ask up front.
A few questions help you gauge quality:
- Do you use ultrasound guidance for every platelet rich plasma injection at the elbow? What platelet concentration do you target, and do you use leukocyte‑poor PRP for tendons? How many PRP procedures for elbow pain do you perform each month? What is your post‑procedure rehab protocol and who coordinates therapy? What are your criteria for a second session, and how long do you wait?
If the answers are vague or dismissive, look elsewhere. Experienced hands and a thoughtful protocol shift outcomes more than fancy marketing.
Setting expectations: what “works” looks like
Patients often ask, does PRP work, and how effective is PRP? The honest answer for elbows: most chronic cases improve meaningfully, not all. In clinical practice, about 70 to 85 percent of appropriately selected tennis elbow patients report substantial pain reduction and functional gains by three months, rising at six months. Medial cases land in a similar range, perhaps a notch lower. Some return to full sport without restriction. A smaller group improves but still has occasional twinges with heavy use. A minority does not respond and moves on to other options.
How long does PRP last? If symptoms resolve and you rebuild capacity, results can last years. We see recurrences when someone resumes the same provocative pattern without addressing mechanics or when general conditioning lapses. Tennis elbow behaves like a capacity problem. PRP raises the ceiling. Training keeps it there.
Procedure options that sometimes get mixed up
PRP injections are not the same as cosmetic platelet procedures. PRP microneedling, a so‑called PRP facial or vampire facial, and PRP under eye rejuvenation target skin quality, wrinkles, and dark circles. Platelet rich plasma injection for joints aims at synovial and cartilage environments, for example PRP injection for knees in osteoarthritis. Those are different protocols and concentrations. PRP therapy for hair loss is yet another domain. We do all of these in a comprehensive practice, but the technique and outcome measures differ. For elbow tendinopathy, the focus is tenocyte biology and mechanical resilience, not collagen plumping or hair regrowth.
PRP in the broader landscape of musculoskeletal care
Beyond elbows, PRP sees use for rotator cuff tendinopathy, partial shoulder tear, hip pain related to gluteal tendinopathy, plantar fasciitis, certain ankle injuries, and chronic knee problems like patellar tendinopathy and knee osteoarthritis. Evidence varies by condition. It is stronger for lateral epicondylitis and patellar tendinopathy than for advanced cartilage repair. For knee osteoarthritis, PRP often outperforms hyaluronic acid in pain relief over six to twelve months, particularly in mild to moderate disease. For meniscus tear that is stable or degenerative, PRP can calm symptoms but does not knit a complex flap back together. For ligament injury, especially low‑grade sprains, PRP may help, but higher grades often need more structured support.
These comparisons matter because many clinics market platelet injections for hair, acne scars, fine lines, and joint pain under the same banner. The term PRP covers a lot of ground, but the nuance lies in preparation, indication, and aftercare. Ask what conditions PRP treats in that specific practice and how they tailor protocols.
Real‑world mistakes that derail outcomes
Three patterns account for most disappointments I see after a decent PRP procedure. First, overdoing it too soon. People feel better at week three and decide to paint the house or play two hours of singles. The tendon is not ready. Second, skipping rehab. Without progressive loading, new collagen aligns haphazardly and capacity stalls. Third, unclear diagnosis. If the wrist extensor tendon was fine and the real culprit was radial tunnel syndrome or cervical referral, PRP will miss the target. Careful assessment avoids this.
A fourth issue is technique. Blind injections rely on surface anatomy. With ultrasound, you see the degenerative nidus, partial tears, and adjacent structures like the radial nerve. Hitting the mark matters.
Practical preparation and aftercare, distilled
Here is a compact checklist I give patients to improve the odds of the best PRP results.
- Two weeks before: stop NSAIDs if safe, discuss blood thinners with your prescribing clinician, and tidy up your work or racket ergonomics. Three days before: hydrate well, prioritize sleep, and avoid heavy forearm training. Day of: eat a light meal, wear a short‑sleeve shirt, arrange a ride if needed. First week after: expect soreness, use acetaminophen or brief icing, keep the bandage dry for 24 hours, begin gentle range of motion, avoid forceful gripping. Weeks 2 to 6: start guided rehab, progress loading as tolerated, avoid spikes in activity, and check in with your clinician at 4 to 6 weeks.
These small steps often separate average outcomes from excellent ones. They are not complicated, but they require attention.
Where PRP fits into a smart plan for elbow pain
If you are early in the course with a few weeks of pain, begin with load management, technique tweaks, and a focused exercise program. Many improve without injections. If you have crossed the two to three month mark with persistent pain despite doing the right things, PRP becomes a reasonable next move. It pairs best with a structured rehab plan and clear communication about pacing. If your life or work demands a faster short‑term fix and you are comfortable with the trade‑offs, a single corticosteroid injection can buy time while you commit to the rehab that actually resolves the issue. If you have failed both conservative care and one or two well‑done PRP sessions, or if imaging shows substantial tearing, a surgical consult is appropriate.
There is no one right path for everyone. The right choice balances your goals, timeline, risk tolerance, and budget.
A brief note on expectations versus marketing
PRP is not magic. It is a tool, and like any tool, results hinge on the craft of the person using it and the preparation around it. I have seen carpenters return to swinging hammers after years of pain, and tennis players reclaim a confident backhand after nearly quitting the sport. I have also seen enthusiastic patients turned off by rushed procedures in pop‑up med spas or by clinics that advertise everything from cartilage regeneration to youth treatment without matching protocols to evidence. Ask questions, set a sensible timeline, and align the plan with your actual diagnosis.
Frequently asked realities
Is PRP safe? For healthy patients, yes, with low rates of minor side effects and rare complications. Does PRP help joint regeneration? For tendons, it helps repair and remodeling. For cartilage, think symptom relief and better joint environment rather than regrowing thick cartilage in most adults. Is PRP painful? The injection stings and the area aches for a few days. Most find it manageable. Can I exercise after PRP? Yes, but keep it light the first week and follow a graded plan. How long does PRP last? Many maintain gains for a year or more, and often indefinitely when they also build strength and modify load.
If you like before and after stories, the best ones are measured in function. The chef who can lift a cast iron skillet again. The contractor who can twist a screwdriver without a jolt. The pickleball player who stops dreading the third shot. These are the signposts that healing is not only underway, but durable.
PRP for elbow pain, done thoughtfully, is a strong option. It is not the first thing to reach for, and not the last, but it is often the turning point for the person who has tried rest, braces, creams, and a scattering of exercises without a plan. When biology and biomechanics meet, find PRP injection near you tendons remember how to heal.
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