The likely cause and helpful care change by joint

Knee and hip soreness often worsen with weight on the joint

A worn knee may feel stiff after sitting, then loosen with a little movement. Longer walks, stairs, or standing can bring the soreness back.

Hip-joint soreness is often felt in the groin and may limit shoes or socks. A tendon can instead hurt along the hip’s outer side.

PRP is the short name for platelet-rich plasma. Spinning drawn blood separates a liquid rich in platelets, the blood parts that start repair.

A large knee test found about the same relief from PRP and salt water. Hip studies found no more relief from PRP than gel or salt-water shots.

Shoulder and elbow soreness often follow reaching or gripping

Shoulder tendons may hurt when lifting an arm or reaching behind the back. Avoid sharp soreness, but keep gentle motion so the shoulder doesn’t stiffen.

Elbow soreness often rises with gripping, carrying, or turning a tool. Changing the grip and resting briefly from that task may settle it.

For elbow tendons, cortisone groups did better before two months. PRP groups reported more relief at six months and later.

Shoulder tests conflict: one favored PRP over cortisone early, while another found no advantage over salt water. An exam can separate tendon soreness from a tear.

Heel and ankle soreness need different checks

Heel soreness often bites on the first step after sitting or sleeping. Supportive shoes, calf stretches, and less time on hard floors may help.

Ankle soreness may follow an old sprain or joint wear. Swelling, poor balance, and the exact sore spot help the examiner tell them apart.

In heel tests, PRP groups reported more relief than cortisone groups after several months. An ankle test found PRP brought no more relief than salt water.

Sources

1. In the RESTORE trial - the largest placebo-controlled PRP trial in knee osteoarthritis - 288 adults aged 50+ with symptomatic Kellgren-Lawrence grade 2-3 medial knee OA received three weekly intra-articular injections of leukocyte-poor PRP from a commercial system or saline placebo. At 12 months the mean change in knee pain was -2.1 points with PRP versus -1.8 with saline (difference -0.4; 95% CI -0.9 to 0.2; P=.17) against a minimum clinically important difference of 1.8, and the change in medial tibial cartilage volume was -1.4% versus -1.2% (difference -0.2%; 95% CI -1.9% to 1.5%; P=.81). Twenty-nine of 31 prespecified secondary outcomes showed no significant between-group difference. The authors concluded the findings do not support use of PRP for knee OA.

   Bennell KL, Paterson KL, Metcalf BR, et al. — Effect of Intra-articular Platelet-Rich Plasma vs Placebo Injection on Pain and Medial Tibial Cartilage Volume in Patients With Knee Osteoarthritis: The RESTORE Randomized Clinical Trial. JAMA, 2021. DOI: 10.1001/jama.2021.19415.

2. A meta-analysis of 18 Level I randomized trials (811 patients receiving PRP, 797 receiving hyaluronic acid, mean follow-up 11.1 months) found mean improvement in total WOMAC scores was significantly higher with PRP (44.7%) than with hyaluronic acid (12.6%) (P<.01), and 6 of 11 VAS-reporting studies found significantly less pain with PRP at latest follow-up.

   Belk JW, Kraeutler MJ, Houck DA, et al. — Platelet-Rich Plasma Versus Hyaluronic Acid for Knee Osteoarthritis: A Systematic Review and Meta-analysis of Randomized Controlled Trials. American Journal of Sports Medicine, 2021. DOI: 10.1177/0363546520909397.

3. A meta-analysis of eight studies (648 patients, mean age 59) judged at low risk of bias found PRP significantly better than intra-articular corticosteroid for knee OA symptoms at 3, 6 and 9 months (P<0.01), with the largest effects at 6 months (SMD -0.78; 95% CI -1.34 to -0.23) and 9 months (SMD -1.63; 95% CI -2.14 to -1.12). This is the strongest available case for PRP as a longer-acting alternative to a steroid shot.

   McLarnon M, Heron N — Intra-articular platelet-rich plasma injections versus intra-articular corticosteroid injections for symptomatic management of knee osteoarthritis: systematic review and meta-analysis. BMC Musculoskeletal Disorders, 2021. DOI: 10.1186/s12891-021-04308-3.

4. The ESSKA-ICRS consensus applied the RAND/UCLA appropriateness method to 216 clinical scenarios for intra-articular PRP in knee OA. Only 84 scenarios (38.9%) were rated appropriate, 9 (4.2%) inappropriate and 123 (56.9%) uncertain. PRP was judged appropriate in patients aged 80 or under with KL grade 0-III osteoarthritis AFTER failed conservative non-injective or injective treatment; it was NOT considered appropriate as a first treatment, nor in KL grade IV (bone-on-bone) osteoarthritis, where 91.7% and 87.5% of scenarios respectively were uncertain.

   Kon E, de Girolamo L, Laver L, et al. — Platelet-rich plasma injections for the management of knee osteoarthritis: The ESSKA-ICRS consensus. Recommendations using the RAND/UCLA appropriateness method for different clinical scenarios. Knee Surgery, Sports Traumatology, Arthroscopy, 2024. DOI: 10.1002/ksa.12320.

5. A meta-analysis of 11 randomized trials (730 patients) with lateral epicondylitis found corticosteroid better than PRP in the short term (under 2 months) on VAS pain (MD 0.93; 95% CI 0.42-1.44) and DASH (MD 10.23; 95% CI 9.08-11.39), while PRP was better in the long term (6 months or more) on VAS (MD -2.18; 95% CI -3.13 to -1.22), DASH (MD -8.13) and Mayo Elbow Performance Score (MD 16.53). The two treatments trade places over time rather than one dominating.

   Xu Y, Li T, Wang L, et al. — Platelet-Rich Plasma Has Better Results for Long-term Functional Improvement and Pain Relief for Lateral Epicondylitis: A Systematic Review and Meta-analysis of Randomized Controlled Trials. American Journal of Sports Medicine, 2024. DOI: 10.1177/03635465231213087.

6. A systematic review and meta-analysis of nine randomized trials (239 PRP patients, 240 corticosteroid patients) in chronic plantar fasciitis found statistically significant differences in VAS pain favouring PRP at 1-1.5, 3, 6 and 12 months, and in AOFAS function favouring PRP at 6 and 12 months (no difference at 1 and 3 months).

   Hurley ET, Shimozono Y, Hannon CP, et al. — Platelet-Rich Plasma Versus Corticosteroids for Plantar Fasciitis: A Systematic Review of Randomized Controlled Trials. Orthopaedic Journal of Sports Medicine, 2020. DOI: 10.1177/2325967120915704.

7. In a randomized comparative trial of chronic severe recalcitrant plantar fasciitis, the corticosteroid group's mean AOFAS score rose from 52 to 81 at three months but fell back to 58 at 12 months and 56 at 24 months, while the PRP group rose from 37 to 95 at three months and held at 92 at 24 months. The pattern - steroid relief that fades, PRP relief that persists - is the clearest single illustration of the durability difference.

   Monto RR — Platelet-rich plasma efficacy versus corticosteroid injection treatment for chronic severe plantar fasciitis. Foot & Ankle International, 2014. DOI: 10.1177/1071100713519778.

8. A double-blind randomized controlled trial of 99 patients with imaging-proven partial-thickness rotator cuff tears or tendinopathy compared ultrasound-guided PRP with corticosteroid, following patients to 12 months. PRP produced significantly better short-term pain relief and function than corticosteroid on VAS, ASES and WORC scores.

   Kwong CA, Woodmass JM, Gusnowski EM, et al. — Platelet-Rich Plasma in Patients With Partial-Thickness Rotator Cuff Tears or Tendinopathy Leads to Significantly Improved Short-Term Pain Relief and Function Compared With Corticosteroid Injection: A Double-Blind Randomized Controlled Trial. Arthroscopy, 2021. DOI: 10.1016/j.arthro.2020.10.037.

9. A randomized double-blind trial of 80 patients with chronic gluteal tendinopathy (lateral hip pain) compared a single ultrasound-guided PRP injection with a single corticosteroid injection. At 12 weeks the PRP group had significantly better modified Harris Hip Scores (P=.048), and 82% versus 56.7% of patients reached the minimal clinically important difference (P=.016).

   Fitzpatrick J, Bulsara MK, O'Donnell J, et al. — The Effectiveness of Platelet-Rich Plasma Injections in Gluteal Tendinopathy: A Randomized, Double-Blind Controlled Trial Comparing a Single Platelet-Rich Plasma Injection With a Single Corticosteroid Injection. American Journal of Sports Medicine, 2018. DOI: 10.1177/0363546517745525.

10. A network meta-analysis of 11 randomized trials (1353 patients) with HIP osteoarthritis found that for both pain and function, at 2-4 months and at 6 months, NO intervention - corticosteroid, hyaluronic acid or PRP - significantly outperformed an intra-articular saline placebo injection.

    Gazendam A, Ekhtiari S, Bozzo A, et al. — Intra-articular saline injection is as effective as corticosteroids, platelet-rich plasma and hyaluronic acid for hip osteoarthritis pain: a systematic review and network meta-analysis of randomised controlled trials. British Journal of Sports Medicine, 2021. DOI: 10.1136/bjsports-2020-102179.

11. A multicentre, double-blinded, placebo-controlled trial randomised 100 patients with ankle (tibiotalar) osteoarthritis to two ultrasound-guided intra-articular injections of PRP or placebo. Symptom scores improved by 10 points with PRP and 11 points with placebo, an adjusted between-group difference over 26 weeks of -1 (95% CI -6 to 3; P=.56). The authors concluded the results do not support the use of PRP injections for ankle osteoarthritis.

    Paget LDA, Reurink G, de Vos RJ, et al. — Effect of Platelet-Rich Plasma Injections vs Placebo on Ankle Symptoms and Function in Patients With Ankle Osteoarthritis: A Randomized Clinical Trial. JAMA, 2021. DOI: 10.1001/jama.2021.16602.

12. A placebo-controlled, double-blind randomized trial of 40 patients with chronic rotator cuff tendinopathy compared a single ultrasound-guided subacromial injection of 5 mL PRP with 5 mL saline, with both groups completing a 6-week standard exercise programme and follow-up to one year. PRP did not produce better outcomes than saline on any measure - a reminder that the exercise programme, not the injectate, carried the improvement.

    Kesikburun S, Tan AK, Yilmaz B, et al. — Platelet-rich plasma injections in the treatment of chronic rotator cuff tendinopathy: a randomized controlled trial with 1-year follow-up. American Journal of Sports Medicine, 2013. DOI: 10.1177/0363546513496542.