How Many Cortisone Shots Can I Have?

Female nurse filling syringe
Cortisone injections are powerful anti-inflammatory treatments. Hero Images/Getty

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.  So why do physicians recommend against too many shots, and just how many is too much?

Cortisone Injections

First, a bit about cortisone injections: They are used in treating many common orthopedic conditions, and they work by decreasing inflammation of irritated tissues.

By limiting the inflammation, pain from these conditions is often relieved. Cortisone injections are used for many orthopedic problems, including:

Patients often hear that they can only have a limited number of cortisone injections. Sometimes they are told only three injections, or perhaps three injections in one year, or perhaps something else. So what is the limit for the number of cortisone injections?  And why do doctors place limits on the number of injections they will give for a treatment that seems to be effective?

So, How Many Can You Have?

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:

  • The cortisone injections are not helping
    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 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.

    Bottom Line: How Many?

    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. Patients 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 to a patient.

    Sources:

    Cole BJ and Schumacher HR "Injectable Corticosteroids in Modern Practice" J. Am. Acad. Ortho. Surg., January/February 2005; 13: 37 - 46.

    Fadale PD and Wiggins ME "Corticosteroid Injections: Their Use and Abuse" J. Am. Acad. Ortho. Surg., May 1994; 2: 133 - 140.

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