A tendon injection places your own platelet-rich plasma or other orthobiologic right into and around a damaged tendon under live ultrasound. We use it when rest, therapy and cortisone have not fixed the pain. That covers the rotator cuff, tennis and golfer’s elbow, and gluteal tendons at the outer hip. It also covers the Achilles, the patellar tendon and the plantar fascia.
A chronic tendon is a rope that has started to fray. The fibers lose their tight parallel lines, the tissue fills with disorganized scar, and new blood vessels and nerves grow into places they do not belong. That is why it hurts every time you load it. Most chronic tendon pain is a failed repair. The tissue tried to heal, stalled, and stayed stalled.
Tendons have a poor blood supply to begin with. Repair workers arrive slowly and leave early. A tendon injection delivers them straight to the frayed section. That only works if the needle is in the frayed section.
A tendon problem is often a few millimeters wide. The damaged part can sit right next to healthy fibers and a fluid-filled bursa. That is true of a gluteal tendon, a supraspinatus tear or a tennis-elbow origin. Inject the bursa and you have treated the wrong structure. Inject a healthy section and you have wasted the product.
Under ultrasound we see the dark, swollen, messy area of the tendon. We see any partial tear and the abnormal blood vessels growing into it. We guide the needle into that zone. Then we spread the injection through it in several small passes. Each pass also breaks up the stalled scar and restarts the healing signal. Blind injection cannot do that. Read why on blind needle accuracy.
Cortisone feels better first. PRP lasts longer. That pattern repeats across tendons:
The reason is mechanical. Cortisone weakens collagen. A tendon that already lost its structure does not need a drug that loosens what is left. A 2025 meta-analysis of 27 trials reached the same conclusion. It covered rotator cuff, elbow, plantar fascia and tenosynovitis. PRP’s mid-term results beat cortisone’s.
Because tendons are metabolic tissue. Three drivers keep a tendon from healing:
That is why lifestyle and behavior are 40 to 50% of our protocol. We build laser therapy, rehabilitation and metabolic optimization around the injection.
The injection restarts healing. Rehab teaches the new fibers which direction to line up. Protect the area for the first few days and follow the rehab plan. After that, the plan moves to slow, controlled loading of the tendon. It is the same idea shown in the rotator cuff exercise evidence. A tendon that is never loaded heals weak. A tendon that is overloaded tears again.
You can’t make a carrot grow faster than it grows. Collagen remodels over months. Some feel better in three weeks. Others need a second or third treatment, based on how the tissue responds.
We draw your blood and process it in an FDA-cleared preparation system. The skin is numbed with local anesthetic. You stay awake. You can watch the ultrasound screen if you want. Most patients drive themselves home. Expect soreness for about 48 hours after PRP. For tendons that have failed injections, TenJet debridement is another option.
No. A bursa is a fluid sac next to the tendon. Under ultrasound we treat the damaged tendon itself. We only treat the bursa if it is part of the problem.
Yes. Conservative care matches surgery for partial-thickness cuff tears, which are about twice as common as full-thickness ones. A 2026 meta-analysis of 33 studies and 1,818 patients found that the extra gains from surgery “remained below the minimal clinically important differences (MCID), indicating limited clinical relevance.” Pooled trials also show PRP improves shoulder function more than cortisone, with fewer side effects. A full-thickness tear with retraction is the exception. For partial tears, we place PRP into the tendon under ultrasound, pair it with a loading program and work to avoid surgery.
Protect the area for the first few days and follow the rehab plan. It then builds load in steps.
Some feel better in three weeks. Others need a second or third treatment, based on how the tissue responds.
Cortisone relieves pain faster in the first weeks. But it weakens collagen. For tendons, PRP produces better results at six months and beyond.
Orthobiologics are not billed to insurance. HSA and FSA funds are generally eligible.
If a shoulder, elbow, hip, heel or Achilles has outlasted rest, therapy and cortisone, a precise ultrasound-guided tendon injection is the bridge between failed conservative care and surgery. We see patients at our office at 4477 Woodson Rd in St. Louis. Over 90% of our accepted case-study patients see significant improvement. Request our orthobiologics guide or call (314) 481-5000 to find out whether your tendon is a candidate.
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