PRP tendon evidence Arizona: what to do when a tendon stays sore

What to show the doctor during the exam

A sore tendon may hurt during one motion, such as reaching, gripping, or pushing off. A joint problem can feel similar, so the exam must sort them out. Point to the painful spot instead of trying to name the cause yourself.

The named body part matters because each tendon has different study results.

Tell the doctor how long it has hurt and whether rest eases it. Mention a sudden pull, a fall, or a slow rise in activity. The doctor may then decide whether a scan would add useful information.

What the tendon studies found

Tennis elbow studies found little early difference, followed by less soreness after more time. Shoulder results split: one trial found less soreness and easier use for a while, while another found no more help than a saltwater shot. Studies of the Achilles cord behind the ankle found no added relief or better movement.

The same blood shot does not give the same result in every body part.

Heel studies found longer relief than a steroid shot after several months, though the research had weak spots. One outer-hip trial also found longer relief than a steroid shot. These findings support questions, not a promise about your result.

What to ask about the blood used for PRP

Some PRP preparations keep more white blood cells, while others remove most of them. The amount of platelets can differ as well. Ask what will go into the shot and why that form was chosen for the named tendon.

One tendon's study cannot answer for a different tendon.

Ask whether less soreness, stronger grip, easier reaching, or steadier walking would show progress. Compare the shot with exercise, medicine, more time, and surgery. Also ask about recovery and what follows if the ache stays the same.

Evidence sources

1. A 12-centre randomized controlled trial of 230 patients with chronic lateral epicondylar tendinopathy compared tendon needling with leukocyte-enriched PRP against tendon needling alone. At 12 weeks there was no significant difference (55.1% versus 47.4% pain improvement; P=.163). At 24 weeks the PRP group reported 71.5% versus 56.1% pain improvement (P=.019), a 83.9% versus 68.3% success rate (P=.037), and significantly less residual elbow tenderness (29.1% versus 54.0%; P=.009). No significant complications occurred in either group.

   Mishra AK, Skrepnik NV, Edwards SG, et al. — Efficacy of platelet-rich plasma for chronic tennis elbow: a double-blind, prospective, multicenter, randomized controlled trial of 230 patients. American Journal of Sports Medicine, 2014.

2. A meta-analysis of 11 randomized trials (730 patients) with lateral epicondylitis found corticosteroid better than PRP in the short term (under 2 months) on VAS pain (MD 0.93; 95% CI 0.42-1.44) and DASH (MD 10.23; 95% CI 9.08-11.39), while PRP was better in the long term (6 months or more) on VAS (MD -2.18; 95% CI -3.13 to -1.22), DASH (MD -8.13) and Mayo Elbow Performance Score (MD 16.53). The two treatments trade places over time rather than one dominating.

   Xu Y, Li T, Wang L, et al. — Platelet-Rich Plasma Has Better Results for Long-term Functional Improvement and Pain Relief for Lateral Epicondylitis: A Systematic Review and Meta-analysis of Randomized Controlled Trials. American Journal of Sports Medicine, 2024.

3. A meta-analysis of 20 trials (1268 participants) covering elbow epicondylitis and plantar fasciitis found that for epicondylitis PRP gave a statistically and clinically meaningful long-term improvement in pain versus corticosteroid, with a very large effect size of -1.3 (95% CI -1.9 to -0.7), but the evidence level was LOW; there was moderate evidence that corticosteroid gave better short-term (1-3 month) pain relief than PRP.

   Huang K, Giddins G, Wu LD — Platelet-Rich Plasma Versus Corticosteroid Injections in the Management of Elbow Epicondylitis and Plantar Fasciitis: An Updated Systematic Review and Meta-analysis. American Journal of Sports Medicine, 2020.

4. A systematic review of 26 studies of PRP for lateral epicondylitis assessed against minimal clinically important difference thresholds rather than statistical significance found the mean improvement exceeded the MCID from week 4 through week 104 for VAS and DASH, and from weeks 4-52 for the Mayo score. Both leukocyte-rich and leukocyte-poor systems met the MCID at almost every observation point.

   Niemiec P, Szyluk K, Jarosz A, et al. — Effectiveness of Platelet-Rich Plasma for Lateral Epicondylitis: A Systematic Review and Meta-analysis Based on Achievement of Minimal Clinically Important Difference. Orthopaedic Journal of Sports Medicine, 2022.

5. A placebo-controlled, double-blind randomized trial of 40 patients with chronic rotator cuff tendinopathy compared a single ultrasound-guided subacromial injection of 5 mL PRP with 5 mL saline, with both groups completing a 6-week standard exercise programme and follow-up to one year. PRP did not produce better outcomes than saline on any measure - a reminder that the exercise programme, not the injectate, carried the improvement.

   Kesikburun S, Tan AK, Yilmaz B, et al. — Platelet-rich plasma injections in the treatment of chronic rotator cuff tendinopathy: a randomized controlled trial with 1-year follow-up. American Journal of Sports Medicine, 2013.

6. A double-blind randomized controlled trial of 99 patients with imaging-proven partial-thickness rotator cuff tears or tendinopathy compared ultrasound-guided PRP with corticosteroid, following patients to 12 months. PRP produced significantly better short-term pain relief and function than corticosteroid on VAS, ASES and WORC scores.

   Kwong CA, Woodmass JM, Gusnowski EM, et al. — Platelet-Rich Plasma in Patients With Partial-Thickness Rotator Cuff Tears or Tendinopathy Leads to Significantly Improved Short-Term Pain Relief and Function Compared With Corticosteroid Injection: A Double-Blind Randomized Controlled Trial. Arthroscopy, 2021.

7. A meta-analysis of eight randomized trials of PRP for rotator cuff tendinopathy concluded PRP was a safe and effective intervention for long-term pain control and shoulder function - while noting that the studies varied in PRP preparation and injection technique and that the control interventions differed between trials (saline in four, rehabilitation or dry needling in the other four).

   A Hamid MS, Sazlina SG — Platelet-rich plasma for rotator cuff tendinopathy: A systematic review and meta-analysis. PLOS ONE, 2021.

8. A systematic review and meta-analysis of nine randomized trials (239 PRP patients, 240 corticosteroid patients) in chronic plantar fasciitis found statistically significant differences in VAS pain favouring PRP at 1-1.5, 3, 6 and 12 months, and in AOFAS function favouring PRP at 6 and 12 months (no difference at 1 and 3 months).

   Hurley ET, Shimozono Y, Hannon CP, et al. — Platelet-Rich Plasma Versus Corticosteroids for Plantar Fasciitis: A Systematic Review of Randomized Controlled Trials. Orthopaedic Journal of Sports Medicine, 2020.

9. A meta-analysis of 15 studies in plantar fasciitis found PRP superior to corticosteroid on AOFAS at 6 and 12 months (P=.009 both) and on VAS at 3, 6 and 12 months, with no advantage in the first month. The authors added the caveat that nine of the fifteen studies had a high risk of bias and that 'different protocols for PRP preparation reduce the internal and external validity of these findings' - the preparation problem stated as an explicit limit on the conclusion.

   Hohmann E, Tetsworth K, Glatt V — Platelet-Rich Plasma Versus Corticosteroids for the Treatment of Plantar Fasciitis: A Systematic Review and Meta-analysis. American Journal of Sports Medicine, 2021.

10. A 2024 systematic review and meta-analysis comparing PRP with other modalities for plantar fasciitis found PRP more effective than corticosteroid injection, extracorporeal shockwave therapy and placebo on VAS pain, and better than corticosteroid and placebo on AOFAS - but found no consistent advantage across every outcome measured, and called for a more standardised approach to PRP preparation and outcome measurement.

    Herber A, Covarrubias O, Daher M, et al. — Platelet rich plasma therapy versus other modalities for treatment of plantar fasciitis: A systematic review and meta-analysis. Foot and Ankle Surgery, 2024.

11. In a double-blind, placebo-controlled trial of 54 patients with chronic midportion Achilles tendinopathy, all doing eccentric exercises, VISA-A scores improved 21.7 points with PRP and 20.5 points with saline over 24 weeks - an adjusted between-group difference of -0.9 (95% CI -12.4 to 10.6), excluding the predefined relevant difference of 12 points. PRP added nothing to eccentric loading.

    de Vos RJ, Weir A, van Schie HT, et al. — Platelet-rich plasma injection for chronic Achilles tendinopathy: a randomized controlled trial. JAMA, 2010.

12. A 24-site, 240-patient participant-blinded randomized trial of a single intratendinous PRP injection versus a sham (subcutaneous dry needle) for chronic midportion Achilles tendinopathy found VISA-A scores of 54.4 versus 53.4 at six months (adjusted mean difference -2.7; 95% CI -8.8 to 3.3) against a 12-point minimal clinically important difference. The authors stated the findings do not support the use of this treatment for chronic midportion Achilles tendinopathy.

    Kearney RS, Ji C, Warwick J, et al. — Effect of Platelet-Rich Plasma Injection vs Sham Injection on Tendon Dysfunction in Patients With Chronic Midportion Achilles Tendinopathy: A Randomized Clinical Trial. JAMA, 2021.

13. An updated meta-analysis of six randomized trials (422 patients) found no benefit of PRP over placebo for Achilles tendinopathy on VISA-A at 3 months (mean difference 1.7; 95% CI -1.8 to 5.2), 6 months (0.5; 95% CI -8.5 to 9.3) or 1 year (-7.9; 95% CI -27.3 to 11.6), nor on VAS pain at 3 months. Funnel-plot asymmetry suggested publication bias inflating apparent benefits. The authors wrote that PRP should not be used to treat Achilles tendinopathy until high-quality trials show a clear clinical benefit.

    Barreto ESR, Antunes Junior CR, Silva IC, et al. — Is Platelet-rich Plasma Effective in Treating Achilles Tendinopathy? A Meta-analysis of Randomized Clinical Trials. Clinical Orthopaedics and Related Research, 2025.

14. A randomized double-blind trial of 80 patients with chronic gluteal tendinopathy (lateral hip pain) compared a single ultrasound-guided PRP injection with a single corticosteroid injection. At 12 weeks the PRP group had significantly better modified Harris Hip Scores (P=.048), and 82% versus 56.7% of patients reached the minimal clinically important difference (P=.016).

    Fitzpatrick J, Bulsara MK, O'Donnell J, et al. — The Effectiveness of Platelet-Rich Plasma Injections in Gluteal Tendinopathy: A Randomized, Double-Blind Controlled Trial Comparing a Single Platelet-Rich Plasma Injection With a Single Corticosteroid Injection. American Journal of Sports Medicine, 2018.

15. Two-year follow-up of the same 80-patient gluteal tendinopathy trial found the single leukocyte-RICH PRP injection produced improvement that was sustained at 104 weeks (mHHS 53.77 at baseline to 82.59 at two years; P<.0001), whereas the corticosteroid improvement peaked at six weeks and was not maintained beyond 24 weeks. This is one of the clearest demonstrations that leukocyte-rich PRP is the formulation with evidence in TENDON, not in cartilage.

    Fitzpatrick J, Bulsara MK, O'Donnell J, et al. — Leucocyte-Rich Platelet-Rich Plasma Treatment of Gluteus Medius and Minimus Tendinopathy: A Double-Blind Randomized Controlled Trial With 2-Year Follow-up. American Journal of Sports Medicine, 2019.

16. A meta-analysis with bias assessment covering PRP for tendon and ligament healing found significantly less long-term pain with PRP overall (weighted mean difference -0.84; 95% CI -1.23 to -0.44), driven by rotator cuff injuries (-0.53) and lateral epicondylitis (-1.39). Heterogeneity was substantial (I2 about 76%) and the funnel plot was asymmetric, suggesting possible publication bias.

    Chen X, Jones IA, Park C, et al. — The Efficacy of Platelet-Rich Plasma on Tendon and Ligament Healing: A Systematic Review and Meta-analysis With Bias Assessment. American Journal of Sports Medicine, 2018.