TL;DR
For chronic tennis elbow, a 2024 meta-analysis found cortisone injections work faster at one month, while shockwave therapy showed better pain and function results at three and six months.
- Cortisone tends to relieve pain faster in the first month.
- Shockwave therapy showed better results at the three- and six-month marks in the same analysis.
- Reported side effects were similarly low and mild for both options.
- This comparison applies specifically to chronic tennis elbow, not every tendon condition.
If you have chronic tennis elbow and you are deciding between a cortisone shot and shockwave therapy, the honest answer is that the right choice depends on your timeline. Here is what the evidence actually shows.
What is tennis elbow, and why does treatment choice matter?
Tennis elbow, also called lateral epicondylitis, is an overuse injury to the tendons on the outside of the elbow, causing pain that often worsens with gripping or repetitive wrist motion. Chronic cases, meaning symptoms that have persisted for weeks to months despite basic measures like rest and activity modification, are the ones where injections and non-surgical technologies are typically considered.
How do cortisone and shockwave therapy compare?
A 2024 systematic review and meta-analysis pooled six randomized controlled trials directly comparing corticosteroid injection to extracorporeal shockwave therapy (ESWT) for chronic tennis elbow. The corticosteroid group had better pain relief at one month, which makes sense given how quickly a steroid injection can calm inflammation. By three and six months, however, the shockwave group showed better pain and function outcomes than the corticosteroid group.
Reported side effects were similarly low and mild in both groups. This is a meaningful comparison specifically because both treatments were tested against each other in the same trials, rather than each being compared only to no treatment.
What causes tennis elbow in the first place?
Despite the name, most people with tennis elbow have never played tennis. It is an overuse injury from repetitive gripping and wrist-extension motion, common in jobs and hobbies involving repeated hand and forearm use, like painting, plumbing, typing, or racquet sports. Over time, this repetitive stress causes small-scale damage to the tendon fibers on the outside of the elbow, leading to pain, tenderness, and weakened grip strength. Understanding the cause matters because activity modification, not just treatment, is often part of a full recovery plan.
So which option should I choose?
It depends on what you are prioritizing. If you need faster relief, for example ahead of a specific event or because pain is significantly limiting your daily function right now, cortisone’s faster onset may be the more practical choice. If you are more focused on function and pain control over the medium term and are comfortable with a slower initial response, shockwave therapy’s better three- and six-month results may be the better fit. Some patients also use a combination approach over time, though that decision depends on your specific case and how you respond to the first treatment.
This comparison is specific to chronic lateral epicondylitis. It should not be generalized to other tendon or joint conditions, where the evidence for either treatment may look different.
Are there downsides to repeated cortisone injections?
This is worth knowing before deciding. While a single cortisone injection is generally well tolerated, some research has raised questions about repeated steroid injections potentially weakening tendon tissue over time with frequent, repeated use. This is part of why cortisone is typically used thoughtfully rather than as a repeated, ongoing treatment, and why your provider will discuss spacing and total number of injections as part of your plan rather than treating it as something to repeat indefinitely.
What does each procedure actually involve?
A cortisone injection is a brief, in-office procedure using a small needle to place anti-inflammatory medication near the affected tendon. Shockwave therapy uses acoustic wave pulses applied to the skin over the affected area, typically across a series of short sessions rather than a single visit. Neither requires surgery or significant downtime, though your provider will give you specific activity guidance after either option.
What if neither option provides enough relief?
If your symptoms do not improve with either approach, your provider will reassess your diagnosis and discuss other options, which may include a structured physical therapy program focused on eccentric strengthening, bracing, or, in persistent cases that do not respond to conservative care, a referral for further evaluation. Tennis elbow that has not responded to multiple conservative approaches sometimes benefits from a closer look to rule out other contributing factors.
Frequently asked questions
How many shockwave sessions are typically needed for tennis elbow?
This varies by patient and protocol. Your provider will outline a specific plan based on your evaluation and response to treatment.
Does the cortisone shot hurt?
Most patients tolerate it well. Local anesthetic is typically used, and any discomfort is generally brief.
Can I keep playing sports during treatment?
Your provider will give you specific activity guidance based on your symptoms and which treatment you choose. Some activity modification is usually recommended during the initial treatment period.
Is one option safer than the other?
The 2024 meta-analysis found similarly low and mild side effects for both. Your provider can discuss any individual risk factors relevant to your case.
Will I need more than one type of treatment?
Possibly. Some patients do well with a single approach, while others benefit from combining treatment with a structured exercise program. Your provider will tailor this to your response.
Take the next step
If chronic tennis elbow is limiting your daily activity, an evaluation can help you understand which option, or combination, makes sense for your timeline and goals. Contact us and we will get you scheduled.
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