Choosing the Right Tendon Injection: An Expert Guide

Generally, the most effective treatment for most cases of tendonitis is a rehabilitation programme built around strengthening exercises. The keys are exercise and patience. Stubborn cases get extra help from shockwave or GTN patches. Yet even then, some people cannot return to sport. For these complex cases, we use a tendon injection.

Dr Masci performs every type of tendon injection under ultrasound guidance at his London clinics, as one-stop visits from £400. He has also co-authored the published evidence on this exact topic. So what are your options for a tendon injection — and how do you choose the right one?

What are the options for a tendon injection?

Doctors traditionally reach for cortisone — the UK performs over 500,000 cortisone injections a year for arthritis and tendonitis. Cortisone relieves pain well, but it carries real problems for tendons, including weakening and rupture. The alternatives include PRP, sclerosant (glucose) injections, high-volume stripping, hyaluronic acid, needle tenotomy, tendon scraping, and the Tenex procedure.

What is a tendon sheath injection?

Many tendons run inside a sheath — a thin tunnel that lets the tendon glide. A tendon sheath injection places the medication into this sheath, around the tendon, rather than into the tendon itself. This distinction matters enormously with cortisone: injecting corticosteroid directly into a tendon damages and weakens it. A tendon sheath injection provides anti-inflammatory relief while protecting the tendon.

Accuracy is everything. A tendon sheath sits millimetres from the tendon, so a tendon sheath injection can only be performed properly under ultrasound guidance. Never accept a blind tendon injection.

What is the evidence for a tendon injection?

Dr Masci co-authored a paper summarising the evidence for tendon injections in the treatment of tendonitis. The picture it paints: no single injection wins everywhere, and the right choice depends on the tendon.

Cortisone injections for tendonitis

Cortisone relieves tendonitis pain in the short term. The long-term picture worries us. A cortisone injection for tennis elbow helps at 6 weeks but worsens outcomes at 3 months. A study found an increased risk of Achilles tendon rupture after multiple systemic or local cortisone injections.

We still use cortisone for selected tendons — rotator cuff tendonitis, hamstring tendonitis, and De Quervain’s tenosynovitis — but cautiously, always as a tendon sheath injection under ultrasound guidance, never into the tendon itself.

Do steroid injections weaken tendons?

We think so. A study found the mechanical properties of tendons reduced for several weeks after a steroid injection, along with increased collagen disorganisation and necrosis. Whether the weakening persists for months or years remains unknown — another reason to use cortisone sparingly around tendons.

What are the alternatives to cortisone for tendonitis?

PRP injection for tendonitis

Platelet-rich plasma concentrates the platelets from your own blood and injects their growth factors into the tendon to stimulate regeneration. The evidence supports PRP for tennis elbow, plantar fasciitis, hip tendonitis, and shoulder tendonitis. It does not support PRP for mid-portion Achilles tendonitis: a meta-analysis of high-level Achilles studies found no difference between PRP and placebo.

Platelet dose matters in tendons as in joints. For PRP-responsive tendons, Dr Masci offers Arthrex ACP Max — a high-dose system that delivers the full treatment in one injection rather than two or three.

Glucose (sclerosant) injections for tendonitis

Tendonitis causes abnormal blood vessel growth, and small doses of a sclerosant — dextrose or polidocanol — destroy these vessels to reduce pain. Studies support sclerosant injections for Achilles tendonitis and tennis elbow, though results are mixed.

High-volume saline injection for tendonitis

This tendon sheath injection technique for Achilles and patellar tendonitis showed early promise. Still, randomised studies have shown less impressive results — the short-term benefit probably comes from the cortisone in the mixture rather than from the volume.

Needle tenotomy for tendonitis

Percutaneous needle tenotomy repeatedly needles the tendon under local anaesthetic, stimulating bleeding and healing. Evidence suggests that needle tenotomy outperforms several other treatments and is safe, quick, and inexpensive.

Hyaluronic acid for tendonitis

We increasingly use hyaluronic acid as a tendon sheath injection — most commonly for plantaris-associated Achilles tendonitis, where the plantaris tendon rubs against the Achilles. Injecting hyaluronic acid between the two tendons reduces friction and pain.

Tendon scraping for tendonitis

Tendon scraping uses a needle with a special blade to destroy the pain-generating nerves on the tendon surface. Early results are promising for complex Achilles and patellar cases that have failed simpler treatments. Dr Masci has published research on this technique.

Tenex procedure for tendonitis

The Tenex procedure uses ultrasonic energy to remove damaged tendon tissue while preserving the healthy tendon — surgery-level debridement through a needle, under local anaesthetic. It suits upper- and lower-limb tendonitis that has failed everything else, and it avoids the risks of open surgery.

What about stem cells for tendonitis?

One study supports stem cell therapy for patellar tendonitis, but the treatment costs far more than alternatives and provides no evidence of superiority over PRP or needle tenotomy. We do not recommend it.

Which tendon injection for which tendon?

No single injection wins everywhere, so the doctor and patient share the decision. These are our preferred options, tendon by tendon:

Tendon  Preferred injection option 
Tennis elbow PRP or needle tenotomy
Shoulder tendonitis  Cortisone or PRP
Greater trochanteric syndrome Cortisone or PRP
Achilles tendon  Tendon scraping or PRP
Patellar tendon  Tendon scraping 
De Quervain’s tenosynovitis  Cortisone 
Golfer’s elbow  Needle tenotomy or PRP

Whatever the choice, combining the injection with a structured exercise programme improves the outcome.

How much does a tendon injection cost in London?

Dr Masci performs tendon injections as one-stop visits at his Chelsea clinic: consultation, diagnostic ultrasound, and injection in a single appointment. Cortisone tendon sheath injections cost £400; PRP costs £510 for the first injection and £410 thereafter; ACP Max high-dose PRP costs £1,350; and advanced procedures — tendon scraping, needle tenotomy, and Tenex — start from £420. Other clinic locations cost more. Review the full fees here.

Frequently asked questions about tendon injections.

Is a cortisone shot for patellar tendonitis a good option?

Definitely No. A study comparing a cortisone shot with exercise and shockwave for patellar tendonitis found that the cortisone group did worse at 3–6 months. Avoid cortisone in the patellar tendon; tendon scraping serves these cases far better.

Can a cortisone shot help bursitis?

Yes. Bursitis usually forms secondary to tendonitis — trochanteric bursitis in the hip, for example, follows hip tendonitis. A cortisone shot settles the bursitis, but always combine it with physiotherapy to strengthen the underlying tendons.

Will a cortisone shot help a torn ligament?

Generally, no. Ligament tears trigger inflammation followed by healing, and we suspect cortisone impairs that healing. We avoid injecting cortisone into torn ligaments.

Should every tendon injection use ultrasound?

Yes, without exception. Tendon and tendon sheath targets sit millimetres apart, and cortisone in the wrong place weakens the tendon. Ultrasound guidance separates an effective tendon sheath injection from a harmful one. Dr Masci performs over a thousand ultrasound-guided injections a year and teaches these techniques across the UK and Europe.

Final word from Sport Doctor London about tendon injections

So, never treat a tendon injection lightly. Inject only the challenging cases that have failed rehab, shockwave, or GTN — and match the injection to the tendon, because cortisone helps some tendons and harms others. Speak to a doctor with genuine tendon expertise; Dr Masci has co-authored the published evidence on this exact question.

To book a one-stop tendon injection in London, contact his team here or call +44 (0) 203 488 0350.

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