Tennis Elbow Embolization vs. Cortisone and PRP Injections

Injections are one of the most common treatments for tennis elbow. Many people who come to us have had at least one cortisone shot, and some have tried platelet-rich plasma (PRP). If those helped only briefly, or not at all, you may be wondering how embolization compares. The short answer: they work in different ways, have been studied in very different ways, and suit different situations.

Three treatments, three different ideas

• Cortisone (corticosteroid) injection: a strong anti-inflammatory medicine injected near the painful tendon to calm symptoms.
• PRP injection: a sample of your own blood is spun to concentrate platelets, which contain growth factors, and then injected into the tendon area. The goal is to improve the healing environment.
• Embolization: a catheter placed through an artery, usually at the wrist, delivers tiny particles to reduce blood flow to abnormal vessels around the tendon. Those vessels are thought to travel with nerve fibers that help sustain pain.

For more background on how embolization works, start with our tennis elbow embolization guide.

Cortisone shots: fast relief, but often not lasting

Cortisone has been studied in several well-designed randomized trials, and the results are consistent:

• Lancet, 2002 (185 patients). At six weeks, 92% of people given injections reported success, compared with 47% after physical therapy and 32% after waiting. By one year, the order reversed: 69% for injections, 91% for physical therapy and 83% for wait-and-see.
• BMJ, 2006 (198 patients). Injections worked best at six weeks, but 47 of the 65 people who initially did well later relapsed. Long-term results were poorer than with physical therapy.
• JAMA, 2013 (165 patients). Compared with a placebo injection, cortisone led to lower rates of complete recovery or much improvement at one year (83% vs. 96%) and far more recurrences (54% vs. 12%).

AAOS also advises that steroid injections be used very sparingly for tennis elbow, because excessive use can weaken the bone where the tendon attaches. For people with diabetes, cortisone can raise blood sugar, which is one reason some patients look for alternatives. A 2026 case report described embolization in a man with diabetes who had experienced side effects from steroid injections.

The bottom line: cortisone can be a reasonable short-term bridge, for example to get through a demanding few weeks, but it is not a good long-term strategy for most people.

PRP: popular, but the best evidence is disappointing

PRP is widely offered for tennis elbow, often as a self-pay treatment. The strongest summary of the evidence is a 2021 Cochrane review that included 32 randomized or quasi-randomized trials with 2,337 participants. Its conclusions were:

• PRP or whole-blood injections probably provide little or no clinically important benefit for pain or function compared with a placebo injection at three months (moderate-certainty evidence).
• No clinically important benefit was seen at six or twelve months either.
• Side effects were probably not much more common than with placebo, but injections cause pain and carry a small infection risk.

The review's authors concluded that the data do not support the use of PRP or blood injections for lateral elbow pain. AAOS describes the evidence as mixed, with some studies inconclusive and others promising. Patients should know both views.

This article is part of our Embolization Guide.

Embolization: promising, but not yet tested against placebo

Embolization has a very different evidence base. Instead of large randomized trials, it has a handful of small studies without comparison groups:

• A 2017 Japanese pilot study of 24 patients whose tennis elbow had lasted more than six months saw average disability scores fall from 50.8 to 2.7 at two years. About 36% had a second embolization after six months.
• A 2018 Korean study reported clinical success in 73% of 15 treated shoulders and elbows at four months.
• A 2022 study of 10 people with golfer's elbow reported success after 12 of 14 procedures at six months.

Those results look strong, but remember that PRP also looked promising in early uncontrolled studies before randomized trials told a different story. Embolization has not yet been through that test. The full picture is in research and success rates.

How they compare on the practical points

Why fast relief can be misleading

It is easy to judge a treatment by how you feel a week or two later. With tennis elbow, that can steer you wrong. The cortisone trials show a clear pattern: the quicker the relief, the more likely the pain is to return in the months that follow. In the 2006 BMJ trial, most people who did well at six weeks after an injection had relapsed later.

Embolization tends to work the other way. In the 2017 pilot study, average disability scores fell by about half in the first month and continued to improve through six months and beyond. That slower pattern is one reason we ask patients to judge results over months, not days, and to keep building strength gradually while the elbow settles.

Which might make sense for you?

A cortisone shot may fit if you:

• Need short-term relief for a specific event and accept the risk of relapse.
• Have not had multiple injections already.

PRP is harder to recommend based on current evidence

Some people still choose it. If you do, ask what results the clinic expects and what that is based on.

Embolization may be worth discussing if you:

• Have had pain for six months or more despite exercise therapy and other care.
• Got only brief relief from cortisone, or want to avoid more steroid injections.
• Understand that the evidence is early and a repeat treatment may be needed.

Our candidate guide covers who is and is not a good fit.

Can you combine them?

There is no published research on combining embolization with cortisone or PRP for tennis elbow. If you recently had an injection, tell Dr. Fox the date, since it may affect timing and how your results are interpreted. Whatever you choose, a progressive strengthening program remains the backbone of recovery. To compare embolization across other joints, see our embolization guide.

Frequently Asked Questions

Is embolization better than a cortisone shot for tennis elbow?

They have not been compared directly. Cortisone gives strong short-term relief but often wears off, with a 54% recurrence rate at one year in a JAMA trial. Embolization has shown lasting improvement in small studies but has not been tested against placebo.

Does PRP work for tennis elbow?

A 2021 Cochrane review of 32 trials found PRP probably gives little or no clinically important benefit compared with placebo injections. Some clinicians still use it, and opinions differ.

Can I have embolization after cortisone shots?

Yes. Many patients in the embolization studies had already tried injections. Tell your doctor when your last injection was.

How many cortisone shots are too many for tennis elbow?

There is no single number, but AAOS advises using steroid injections very sparingly for tennis elbow because repeated use can weaken the bone where the tendon attaches.

Keep Reading

• Tennis Elbow Embolization in Manhattan
• Tennis Elbow Embolization vs. Physical Therapy and Bracing
• Tennis Elbow Embolization vs. Surgery: How They Compare
• Elbow Embolization for Athletes and Manual Workers
• Golfer's Elbow Embolization for Medial Epicondylitis
• Is Tennis Elbow Embolization Covered by Insurance?
• Embolization Guide: knee, heel, shoulder, elbow and hip

Sources

1. Smidt et al., The Lancet, 2002 — corticosteroid injection, physiotherapy or wait-and-see for lateral epicondylitis (RCT)
2. Bisset et al., BMJ, 2006 — physiotherapy, corticosteroid injection or wait and see for tennis elbow (RCT)
3. Coombes et al., JAMA, 2013 — corticosteroid injection, physiotherapy or both for lateral epicondylalgia (RCT)
4. Karjalainen et al., Cochrane Database of Systematic Reviews, 2021 — autologous blood and PRP injection for lateral elbow pain
5. American Academy of Orthopaedic Surgeons, OrthoInfo — Tennis Elbow (Lateral Epicondylitis)
6. Kim et al., Medicine (Baltimore), 2026 — case report of embolization for lateral epicondylitis
7. Iwamoto et al., Journal of Shoulder and Elbow Surgery, 2017 — embolization for lateral epicondylitis, 2-year pilot study (24 patients)
8. Kishore et al., ACR Open Rheumatology, 2022 — systematic review of embolization for chronic musculoskeletal pain
9. Hwang et al., Journal of Vascular and Interventional Radiology, 2018 — embolization for shoulder or elbow tendinopathy
10. Lee et al., CardioVascular and Interventional Radiology, 2022 — embolization for chronic medial epicondylitis (10 patients)
11. AuntMinnie, 2019 — SIR report: interventional tennis elbow treatment reduces pain (procedure description)

Medically reviewed by David Fox, MD, FACS, RPVI. This article is general information, not a substitute for a medical evaluation.

Living with joint or tendon pain that hasn’t improved? Schedule a consultation with Dr. David Fox at Fox Vein & Vascular in Manhattan to find out whether embolization is right for you. Call (212) 362-3470 or request an appointment online.