Tennis elbow is a painful condition affecting the outer elbow, common among athletes and anyone who performs repetitive elbow work. Most people assume a cortisone injection is the answer. The evidence says otherwise — a tennis elbow cortisone injection often sets you back rather than forward.

So which tennis elbow injection should you choose, and when? Dr Masci performs every injection option under ultrasound guidance at his London clinics, and he co-authored the published evidence review on this exact question. Here is what the science says.

Tennis elbow symptoms

The common symptoms include aching pain on the outside of the elbow, worse with lifting or sport; pain spreading into the forearm and sometimes the hand; and weakness in the arm and grip. Pain can start gradually or suddenly, and ranges from a mild nuisance to severe and debilitating.

Diagnosis of tennis elbow

A thorough history and examination confirm the diagnosis and assess risk factors such as activity level, diabetes, or rheumatoid arthritis. Typically, the outer elbow is tender and resisted wrist extension hurts.

In complex cases, ultrasound or MRI confirms the degenerative tendon changes and rules out the mimics: radial collateral ligament tear, elbow joint degeneration, and radial tunnel syndrome — a pinched nerve at the elbow.

What is the most effective treatment for tennis elbow?

Exercise. A therapist-supervised programme that strengthens the forearm, elbow, shoulder, and upper back settles most cases, with help from a tennis elbow brace. Most people improve within 6–12 months. A minority do not — and that is when injections enter the conversation. Our complete elbow tendonitis guide covers the full treatment ladder.

Does a cortisone injection in the elbow help tennis elbow?

cortisone injection elbow

No — and this surprises most patients. In a paper co-authored by Dr Masci, there is good evidence that cortisone injections for tennis elbow are not effective. Patients gain short-term relief for up to 6 weeks, then often worsen by 3 months. Many also flare after the injection.

The long-term data are worse still. A study found that patients who had a cortisone injection for tennis elbow did worse at one year than those who had needle tenotomy, or a fake placebo injection. In other words, a cortisone injection in the elbow for tennis elbow can leave you behind where you would have been with no treatment at all.

We still use cortisone for other elbow problems — elbow joint arthritis and selected cases of elbow bursitis-type presentations — at £400 as a one-stop ultrasound-guided visit. For tennis elbow itself, better options exist.

What are the better tennis elbow injection options?

Needle tenotomy

Percutaneous needle tenotomy repeatedly needles the focal tendon damage under ultrasound guidance, stimulating a healing response. A study comparing injection therapies in tennis elbow found needle tenotomy to be the most effective short-term option, and it costs less than PRP, which makes it our usual first-choice injection for tennis elbow.

PRP injection

PRP (platelet-rich plasma) concentrates the platelets from your own blood and injects their growth factors into the degenerative tendon. A review comparing PRP with cortisone found PRP to be the better option for long-term relief. The formula matters — our full PRP for tennis elbow guide explains why we prefer a single superconcentrated injection with Arthrex ACP Max.

Whichever injection you choose, have it under ultrasound guidance — accuracy protects the nerves and ligaments around the elbow and directs the treatment into the damaged tissue.

Non-injection options worth trying first

  • Shockwave therapy: sound waves trigger tendon remodelling; evidence is mixed, and 3–5 sessions are typical.
  • GTN patches: applied to the skin over the tendon each morning and removed at night; trial for 2–3 months alongside exercise. Side effects include headaches and a skin rash.
  • Collagen supplements: taken 30 minutes before tendon-loading exercises, hydrolysed collagen reduces pain more than exercise alone.

And avoid surgery: studies show tennis elbow operations perform no better than sham surgery.

Could something else be causing your elbow pain?

Possibly. Persistent “tennis elbow” sometimes turns out to be elbow instability after a fall — a radial collateral ligament rupture causing subtle instability and ongoing outer elbow pain. Other mimics include elbow arthritis, distal biceps tendonitis, and golfer’s elbow (the same injury on the inner elbow).

Radial tunnel syndrome vs tennis elbow

Radial tunnel syndrome compresses a branch of the radial nerve and closely mimics tennis elbow. The tenderness sits in a different spot, the upper forearm muscles weaken, and an ultrasound can show nerve thickening. Getting this distinction right changes the treatment entirely — including the option of nerve hydrodissection.

What about a tennis elbow tendon tear?

Tears of the extensor carpi radialis tendon are common in longstanding tennis elbow. Most are small, sit on the tendon’s undersurface near the radial collateral ligament, and need the same treatment as tendonitis: simple measures first, then GTN or shockwave, then needle tenotomy or PRP. Surgery applies only to the rare full-thickness, retracted tear.

Frequently asked questions about tennis elbow injections

What is the best injection for tennis elbow?

Needle tenotomy or PRP. Needle tenotomy delivers the best short-term results at the lowest cost; a single superconcentrated PRP injection offers the strongest long-term evidence. Cortisone helps for six weeks, then makes things worse — we advise against it.

How much does a tennis elbow injection cost in London?

At Dr Masci’s Chelsea clinic, standard PRP costs £510 (then £410 for repeats), and ACP Max single-shot superconcentrated PRP costs £1,350, each as a one-stop visit with consultation and diagnostic ultrasound included. Contact us for needle tenotomy fees. Other clinic locations cost more. Full fees here.

I’ve already had a cortisone injection in my elbow. Have I made it worse?

Not permanently. The evidence shows slower recovery and higher recurrence after cortisone, not irreversible damage. Restart a structured exercise programme, and if pain persists, needle tenotomy or PRP remain fully available to you.

How quickly does a tennis elbow injection work?

Needle tenotomy and PRP both make the elbow feel worse before it gets better — expect up to 4 weeks before improvement starts, with gains continuing for months as the tendon remodels.

Final word from Sport Doctor London about tennis elbow injections

Be patient: most cases of tennis elbow settle with exercise alone. For complex cases, try shockwave or GTN patches first, then an injection, and skip the cortisone. Our preferred injection for tennis elbow is needle tenotomy or PRP, always under ultrasound guidance.

To book a one-stop tennis elbow assessment and injection in London, contact Dr Masci’s team here or call +44 (0) 203 488 0350.

Other elbow and hand conditions: