Cortisone injections have been the standard go-to for joint pain for decades. They’re quick, often covered by insurance, and they frequently work — at least for a while. PRP is newer, not usually covered by insurance, and works through a completely different mechanism. Patients deserve a clear-eyed comparison of both, not a sales pitch for either.
How Cortisone Works
Cortisone — technically a corticosteroid — is a powerful anti-inflammatory agent. When injected into a joint or around a tendon, it suppresses the inflammatory response rapidly. For many patients, this provides meaningful relief within days, and that relief can last weeks to months.
The problem is that cortisone is purely symptomatic. It does not repair the tissue that is causing the pain. It quiets the inflammation signal, but the underlying damage — frayed cartilage, degenerated tendon fibers, arthritic joint surfaces — remains unchanged. When the anti-inflammatory effect wears off, the pain tends to return.
More critically, repeated cortisone injections carry documented risks. Multiple studies have shown that frequent corticosteroid injections can actually accelerate cartilage degradation, weaken tendon fibers, and contribute to further joint deterioration over time. For patients with arthritis, regular cortisone injections may provide short-term relief at the cost of long-term joint health.
Most orthopedic guidelines recommend limiting cortisone injections to a small number per year, and many surgeons — Dr. Scheinberg included — are cautious about using them as a recurring management strategy.
How PRP Works
PRP takes the opposite approach. Rather than suppressing the body’s inflammatory signaling, it stimulates a targeted healing response. The concentrated platelets release growth factors — PDGF, TGF-β, VEGF, and others — that signal local cells to repair damaged tissue, reduce chronic inflammation, and support the maintenance of cartilage.
The effects are not as immediate as cortisone. Most patients begin noticing improvement four to eight weeks after PRP treatment. But the benefit builds over time as the healing response matures, and clinical studies have shown that meaningful improvements in pain and function can persist for 12 months or longer.
For tendon injuries, PRP has a particular advantage: cortisone can actually weaken tendon tissue with repeated use, while PRP stimulates tendon repair. For patients with patellar tendonitis, Achilles tendonitis, or rotator cuff tendinopathy, this distinction matters considerably.
The Head-to-Head Evidence
Multiple systematic reviews and meta-analyses have compared PRP directly to cortisone for knee osteoarthritis. The emerging consensus is consistent: PRP tends to outperform cortisone at six months and beyond. One large analysis published in *Military Medicine* found that PRP provided significant pain relief and functional improvement across the 12-month follow-up period, with minor and temporary adverse effects.
For acute inflammation and short-term relief — before a major event, or when pain is acutely limiting function — cortisone can be appropriate and Dr. Scheinberg may use it strategically. But as a long-term management strategy, particularly when the goal is tissue preservation, PRP offers a fundamentally different and more durable value proposition.
How Dr. Scheinberg Approaches the Decision
The choice between cortisone and PRP is not ideological — it’s clinical. Dr. Scheinberg’s approach begins with an honest assessment of what is happening in the joint and what the patient’s goals are.
For a patient who needs short-term relief to get through a specific period — a trip, an event, a temporary flare — cortisone may be the most pragmatic answer. For a patient who wants lasting improvement, is frustrated by returning pain after repeated injections, or who wants to address the underlying problem rather than suppress the symptom, PRP is the more appropriate choice.
What Dr. Scheinberg brings to that decision is 40 years of surgical perspective. He has seen the results of repeated cortisone use in joints he has subsequently operated on. He has also seen PRP produce outcomes that allowed patients to avoid surgery entirely. That longitudinal view shapes every recommendation he makes.
Patients from Santa Barbara, Montecito, and throughout the Central Coast who are stuck in a cycle of cortisone injections that are providing less and less relief are often the ideal candidates for a genuine reassessment — and for a conversation about what PRP might offer them.