Why Did My Cortisone Shot for Tennis Elbow Stop Working?

A cortisone shot calms pain quickly because it suppresses inflammatory signaling, but chronic tennis elbow is mostly a degeneration problem, not an inflammation problem. Cortisone also suppresses the cells that rebuild collagen. A major randomized trial found that at one year, people who received cortisone had worse outcomes and more recurrence than those who received a placebo injection.

Feeling genuinely better for a while and then watching the pain return, sometimes stronger than before, is one of the more disorienting experiences in chronic elbow pain, and it is not something you caused.

The Mechanism

Corticosteroids work by binding receptors inside cells and suppressing the genes that drive inflammation. That mechanism is effective against true inflammation. Chronic tennis elbow is predominantly tendinopathy, disorganized, degenerated collagen with little active inflammation, so there is less for the drug's primary mechanism to act on, and much of the relief comes from dampening pain signaling in the area.

Those same receptors sit on fibroblasts, the cells responsible for producing new tendon collagen, and corticosteroids suppress fibroblast activity. That is a direct problem in a tissue whose core issue is incomplete repair. The injection quiets the alarm while slowing the very cells trying to fix the underlying damage.

The clinical evidence bears this out directly. In a randomized, placebo-controlled trial of 165 patients, researchers found that corticosteroid injection produced significantly worse outcomes at one year compared with placebo injection, with lower rates of complete recovery (83 percent versus 96 percent) and far higher recurrence (54 percent versus 12 percent), despite cortisone producing better results in the first few weeks. A related systematic review and meta-analysis found the same pattern across multiple studies for tennis elbow specifically, concluding that corticosteroid injection helps in the short term but is actually harmful at intermediate and long-term follow-up. Relief also changes behavior: once the pain lifts, people return to the same gripping and lifting activities that originally overloaded the tendon, and the forces causing degeneration, including any cervical nerve root contribution, are usually still present.

When It's Something More Serious

Sudden sharp pain, a popping sensation, or new weakness after an injection needs prompt evaluation, since it can indicate tendon rupture, a recognized risk that rises with repeated injections into the same tendon. Redness, warmth, drainage, or fever at the injection site also needs prompt attention. Any question about repeat injections should be discussed with your physician.

How This Gets Addressed

After an injection wears off, the work is to address what the drug could not.

Dry needling provides a direct stimulus to the degenerated tendon to reactivate collagen repair, and chiropractic care restores cervical and thoracic mechanics so the forearm muscle receives proper nerve input instead of continuing to overload the tendon.

Physical therapy builds graded loading staged to your tendon's actual condition, along with shoulder work to correct how load reaches the forearm, and naturopathic medicine evaluates the nutritional and hormonal factors that determine whether repair can be completed.

Each of these addresses a piece of what the injection left unresolved. You can learn more about our full approach to elbow pain here.

Most patients find that once real repair is stimulated and the cervical and mechanical contributors are corrected, improvement holds longer than the injection's relief did, although recovery is measured in weeks to months and a tendon with a history of multiple injections may need more time to rebuild.

Written By:

Dr. Jason Winkelmann

Naturopathic doctor, Chiropractor, Chronic Pain Specialist, and Educator

Frequently Asked Questions

How long does a cortisone shot for tennis elbow usually last?

Research shows the clearest benefit in the first several weeks, with outcomes becoming worse than placebo by six months and continuing that pattern at one year. How much of that early relief holds depends heavily on whether the forces overloading the tendon, including any neck contribution, are addressed during that window.

Can cortisone make tennis elbow worse in the long run?

Published trial data shows exactly that pattern: corticosteroid injection produced worse recovery rates and more than four times the recurrence rate compared with placebo at one year. Repeated injections into the same tendon are also associated with increasing degeneration and a higher risk of rupture.

What should I do instead of another cortisone shot?

Start with an evaluation of what is actually driving the degeneration, including the cervical spine, shoulder mechanics, and possible nerve entrapment, alongside direct treatment of the tendon itself through graded loading and dry needling. Any decision about further injections should be made with your physician.