Tennis elbow (lateral epicondylitis) treatment in St. Louis starts with the right diagnosis: a worn-out tendon on the outside of the elbow. Cortisone wins for about six weeks. Platelet-rich plasma (PRP) wins after six months, according to a 2024 analysis of eleven randomized trials. We treat the tendon with PRP, rehab and metabolic repair.
Most people with tennis elbow have never played tennis. They are carpenters, mechanics, hairdressers, office workers on a mouse all day, and parents carrying a car seat. The pain sits where the wrist extensor tendons anchor to the bony bump on the outside of the elbow, and it shows up every time you grip, lift a coffee cup or turn a doorknob.
The standard fix is a cortisone shot. It works fast, and that speed is the trap. A 2010 Lancet review of 41 randomized trials found steroid beat doing nothing in the first month, and then the result flipped: by six months and one year, patients who got no injection were doing better. The shot borrowed relief from the future, and the tendon paid it back with interest.
The name lateral epicondylitis ends in “itis,” which means inflammation. Look at the tissue under a microscope and you find something else: disorganized collagen, fragile new vessels, and cells that have stopped repairing. The accurate name is tendinosis, a degenerating tendon. That changes the treatment. Anti-inflammatory drugs and steroid shots target a fire that is mostly out, while the real problem is a repair job that stalled.
Typical signs:
We confirm it with ultrasound in the exam room, which shows thickening, tears inside the tendon and abnormal blood vessels. Pain that tingles into the fingers or comes from the neck gets a different workup.
Because the conditions that wore out the tendon are still there. Three drivers stack on top of each other:
Treat only the elbow and you are mopping the floor while the sink overflows.
This is one of the best-studied uses of PRP anywhere in the body. A 2024 meta-analysis in the American Journal of Sports Medicine pooled eleven randomized trials with 730 patients:
A 2025 analysis of 27 trials across several tendons found the same pattern: PRP pulls ahead of steroid in the middle and later months. The trade is simple. Cortisone buys a fast, short window. PRP starts slower and keeps going, because it feeds the repair instead of shutting it down.
Platelets are the repair workers. Concentrated from your own blood in an FDA-cleared device, they release growth signals that call in new cells, lay down new collagen and rebuild blood supply. We place them into the damaged section of the tendon under ultrasound. Details are on our tendon injection and PRP injections pages.
The procedure is done under local anesthetic. You are awake, there is no sedation, and most patients drive themselves home. Expect soreness for about 48 hours; that is the repair response starting. Protect the area for the first few days and follow the rehab plan.
The number of injections follows clinical need. Some feel better in three weeks; others need a second or third treatment, decided by how the tissue responds. You can’t make a carrot grow faster than it grows. Collagen takes months to mature.
For a tendon that has failed PRP or has a large internal tear, bone marrow concentrate adds the general contractor, cells that direct the repair crew. Severe scar tissue sometimes calls for a debridement procedure.
The injection buys the window. Behavior fills it. Lifestyle and behavioral work is 40 to 50 percent of our protocol:
Dr. Padda is a licensed physician and surgeon, and some elbows do need an operation: a full-thickness tendon rupture, or a tendon that has failed months of well-run care. Orthobiologics are the bridge between failed conservative care and surgery. Most patients who rebuild the tendon never cross that bridge, and those who do arrive with healthier tissue than a tendon softened by repeated steroid.
Cortisone gives the fastest relief, often within days, and it fades. PRP is slower to start and lasts longer. The fastest lasting recovery comes from treating the tendon, the load and the metabolic terrain together.
Each one trades short-term relief for weaker tendon. Trials show steroid patients doing worse at six and twelve months than patients who got no injection. We use PRP instead.
Soreness lasts about 48 hours. Many patients notice change within three to six weeks, and improvement keeps building for six months or more.
Yes. Lateral epicondylitis is the medical name. Lateral epicondylosis or tendinosis describes the tissue more accurately, because it is degenerating rather than inflamed.
No. We use local anesthetic, you stay awake, and most patients drive themselves home.
PRP is not billed to insurance. HSA and FSA funds are generally eligible.
If you have had two cortisone shots and the elbow keeps coming back, the tendon is telling you the plan is wrong. Over 90% of our accepted case-study patients see significant improvement. That is a practice-reported figure from our own population, not a trial outcome, and individual results vary. Request the orthobiologics guide above, or call our office at 4477 Woodson Rd in St. Louis at (314) 481-5000 and we will look at your tendon on ultrasound and tell you what it needs.
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