How Many Cortisone Shots Can I Have?

Are They All Effective Over Time?

cortisone injection given by nurse
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Cortisone injections are commonly used by orthopedic surgeons and other doctors as a treatment for inflammation. While cortisone can be an effective treatment, many doctors will advise against too many cortisone shots—patients may hear that they can only have three, or three per year, for example. How much is too much, and why do doctors advise against more of something that is seemingly helpful?

How Cortisone Injections Work

First, a bit about cortisone injections: They are used in treating multiple common orthopedic conditions, including bursitistendonitis, trigger fingercarpal tunnel syndrometennis elbowknee arthritis, and many other overuse conditions.

They work by decreasing inflammation of irritated tissues. By limiting the inflammation, pain from these conditions is often relieved.

How Effective Are Cortisone Shots?

A 2013 study found that 83 percent of people who got a cortisone shot for tennis elbow recovered or improved within a year. But in that same study, 96 percent who got placebo shots recovered, too. The study involved 165 people in Australia. Half of the people in that study who got cortisone shots had their symptoms return within a year, so the jury is still out on how effective cortisone shots can be over time.

Cortisone shots do not cure every type of orthopedic problem, and despite their broad use in orthopedics they are probably a much more effective treatment for some conditions over others. For example, problems that cause acute inflammation and swelling are more likely to respond effectively to the powerful anti-inflammatory effects of cortisone than a condition that causes more chronic discomfort.

Recommended Maximum

There is no rule about the number of cortisone injections a person can have, but there are some concerns with repeated cortisone injections to one area of the body. If one or two cortisone injections into one region do not help a problem for a sustained period of time, then it is unlikely that more cortisone injections will be of any benefit.

Repeated cortisone injections are also not healthy for tissues. Small amounts of cortisone in the body are probably reasonable, but repeated injections can cause damage to tissues over time. Sometimes this is of little concern. For example, if a patient has severe knee arthritis and a cortisone injection every 6 months helps significantly, then the number of injections probably does not matter too much.

On the other hand, if a patient has shoulder tendonitis, but an otherwise healthy shoulder, the number of injections should probably be limited to prevent further damage to these tendons. It is not accurate to think of cortisone shots as perfectly safe, and there are numerous studies that show that over time people who receive regular injections may sustain more accelerated long-term damage to their joints.

A Word From Verywell

There is no hard and fast rule that says how many cortisone injections can be given over time. However, cortisone injections can have side effects and repeated use of cortisone injections should be done with caution.

You should understand that there are reasons not to use cortisone injections, even if they may help some symptoms. Because of this, most orthopedic surgeons will limit the number of cortisone injections they will offer.

Sources:

Brooke K. Coombes, PhD; Leanne Bisset, PhD; Peter Brooks, MD, FRACP; Asad Khan, PhD; Bill Vicenzino, PhD. "Effect of Corticosteroid Injection, Physiotherapy" Journal of the American Medical Association, Feb. 2013

Hepper CT, at al. The efficacy and duration of intra-articular corticosteroid injection for knee osteoarthritis: a systematic review of level I studies. J Am Acad Orthop Surg. 2009 Oct;17(10):638-46.

McAlindon TE, LaValley MP, Harvey WF, Price LL, Driban JB, Zhang M, Ward RJ. "Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial" JAMA. 2017 May 16;317(19):1967-1975.

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