PRP vs. Cortisone Injection for Shoulder Pain: Which Is Better?
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By Dr. Jeffrey Peng, MD · Published March 5, 2025 · 6 min read
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If you are dealing with persistent shoulder pain — whether from a rotator cuff tear, tendinopathy, or impingement — your doctor may have recommended a cortisone injection. Cortisone is a well-established treatment that can provide quick symptom relief. But recent clinical evidence suggests that platelet-rich plasma (PRP) may offer superior long-term results for many shoulder conditions.
In this post, we will compare cortisone and PRP injections for shoulder pain, review the evidence from two recent systematic reviews, and discuss the practical considerations that should guide your treatment decision.
What Is a Cortisone Injection?
Cortisone injections are a common treatment for patients with shoulder pain. They work by delivering a potent anti-inflammatory medication directly into the affected area, which can quickly reduce pain, swelling, and improve mobility. Cortisone is often recommended after conservative measures — such as physical therapy, rest, and oral medications — have failed to provide adequate relief.
While cortisone injections are not a permanent solution, they can provide meaningful temporary relief and may allow patients to participate in rehabilitation, avoid surgery, or return to normal activities. They are widely available, well-covered by insurance, and considered safe when used appropriately.
What Is Platelet-Rich Plasma (PRP)?
PRP stands for platelet-rich plasma. It is a concentrated solution of platelets and growth factors derived from your own blood. The procedure begins with a standard blood draw into a specialized tube, which is then placed in a centrifuge to separate the platelets from the rest of the blood components. Once isolated, the concentrated platelets are drawn into a syringe and injected under ultrasound guidance into the affected area. The entire process takes less than one hour and is performed under local anesthesia.
The goal of PRP treatment is to promote healing and tissue remodeling by stimulating the body's natural repair mechanisms. PRP injections can potentially provide longer-lasting pain relief and may be more effective than cortisone for certain types of shoulder injuries. However, PRP is not covered by insurance, and the average cost in the United States is approximately $700 per injection (Everts et al., 2020).
PRP vs. Cortisone for Rotator Cuff Disease: What the Research Shows
Two recent systematic reviews and meta-analyses have compared cortisone to PRP for shoulder conditions. Systematic reviews are among the highest levels of clinical evidence because they pool data from multiple studies, reducing bias and increasing statistical power.
Rotator Cuff Disease (Impingement, Tendinopathy, and Tears)
The first systematic review examined how PRP compared to cortisone across the spectrum of rotator cuff disease, including shoulder impingement, rotator cuff tendinopathy, and rotator cuff tears. The authors compiled and analyzed data from nine clinical studies. Their findings revealed that in the short term, cortisone injections were superior to PRP for both pain and functional scores. However, in the long term, PRP produced significantly better outcomes.
Rotator Cuff Tears Specifically
The second systematic review and meta-analysis focused specifically on clinical trials comparing PRP to cortisone for rotator cuff tears. This analysis included 16 studies and found no significant differences between PRP and cortisone for short-term pain relief and functional improvement. However, in the long term, PRP again produced superior outcomes (Lin et al., 2023).
Taken together, these two meta-analyses strongly suggest that PRP is the better long-term option for rotator cuff disease. But does this mean everyone should choose PRP over cortisone? Not necessarily.
When Should You Choose Cortisone Over PRP?
Despite PRP's advantages in long-term outcomes, there are several clinical scenarios where cortisone remains the better first-line choice.
Cost
PRP injections are not covered by insurance. With an average cost of around $700 per treatment, PRP is not affordable for everyone. Cortisone injections, on the other hand, are nearly always covered by insurance, making them far more accessible.
Antiplatelet Medications
Patients with underlying cardiovascular disease — such as coronary artery disease or a history of stroke — are typically prescribed antiplatelet agents like aspirin or clopidogrel. Receiving PRP may require discontinuing these medications for four to six weeks, which could significantly increase the risk of a major cardiovascular event. For these patients, cortisone is the safer choice.
Systemic Inflammatory Conditions
Patients with systemic inflammatory disorders such as rheumatoid arthritis often experience pain in multiple joints and may need to take daily NSAIDs or low-dose steroids to manage their symptoms. Since NSAIDs can interfere with PRP's mechanism of action, cortisone is generally a more practical option for these individuals. The same consideration applies to patients who are taking NSAIDs for other medical procedures or surgeries.
What I Recommend to My Patients
In my practice, I still recommend cortisone injections as the first-line injection treatment for most patients with rotator cuff disease who have not responded to conservative care. The primary reason is that cortisone is effective, affordable, and widely accessible.
There is also an important diagnostic advantage. Shoulder pain is incredibly complex. It is not uncommon for an MRI to show signs of shoulder impingement, rotator cuff tendinopathy, a partial rotator cuff tear, biceps tendonitis, shoulder arthritis, and a labral tear — all in the same patient. By injecting cortisone along with a numbing agent into the area where we suspect the pain is originating, we can assess whether the injection provides relief. If symptoms improve, it serves as a positive diagnostic test. If there is no change, the pain is likely coming from a different structure, and we continue investigating.
Using PRP as a diagnostic tool is impractical due to its cost. For this reason, I typically recommend starting with cortisone to diagnose and potentially treat the problem. If pain persists or recurs after a cortisone injection, we can then transition to PRP as a longer-term solution.
Finally, it is important to remember that injection therapy is just one component of a comprehensive treatment plan for shoulder pain and rotator cuff pathology. A structured exercise program focused on strengthening and rehabilitation is equally — if not more — important for long-term recovery.
References
1. Chen X, Jones IA, Park C, Vangsness CT Jr. The efficacy of platelet-rich plasma on tendon and ligament healing: A systematic review and meta-analysis with bias assessment. Am J Sports Med. 2023;51(3):798–814. PubMed
2. Lin KY, Chen PC, Chen AC, Jiang CC. Platelet-rich plasma injection is superior to corticosteroid injection for the treatment of rotator cuff tears: A systematic review and meta-analysis. J Orthop Surg Res. 2023;18:271. doi:10.1186/s13018-023-03747-z
3. Everts P, Onishi K, Jayaram P, Lana JF, Mautner K. Platelet-rich plasma: New performance understandings and therapeutic considerations in 2020. Int J Mol Sci. 2020;21(20):7794. PMC
Medical Disclaimer: This content is for educational purposes only and does not substitute for the medical advice of a physician. Always consult your healthcare provider before beginning any new treatment program. The information presented reflects the opinion of Dr. Jeffrey Peng and does not represent the views of his employers or affiliated hospital systems.
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