How Many Cortisone Shots Can You Have?

Cortisone injections are commonly used by orthopedic surgeons and other healthcare providers as a treatment for joint pain and inflammation. While cortisone injections can be extremely effective, healthcare providers will advise against getting too many shots due to possible harms.

This article explains how cortisone shots work and their overall effectiveness in reducing joint pain and inflammation. It also outlines the maximum number of shots a person should receive per year and the risks of overuse.

How Cortisone Injections Work

Cortisone injections are used to treat many joint problems, including bursitis, tendonitis, trigger finger, carpal tunnel syndrome, tennis elbow, knee arthritis, and many types of overuse injuries.

Cortisone is a type of steroid hormone that work by decreasing inflammation. Inflammation is the body's normal response to an injury, infection, or disease as a means to heal itself. However, when a condition is persistent and the inflammation is chronic, the symptoms of inflammation—including pain and swelling—can become intolerable.

By decreasing inflammation in a joint space with cortisone, pain and swelling can be reduced and joint mobility can be improved. Shots given into a joint space are referred to as intra-articular injections.

Effectiveness

A 2013 study in the Journal of the American Medical Association (JAMA) found that 83% of people who received a cortisone shot for tennis elbow improved or recovered within a year. Even so, around half who received cortisone experienced a return of symptoms within a year.

This highlights one of the limitations of cortisone injections: They can provide rapid, effective relief of joint pain and stiffness, but they are not considered permanent solutions.

Moreover, cortisone shots do not help every orthopedic problem. Those with acute inflammation (meaning inflammation that is rapidly developing and recent) tend to respond well to intra-articular cortisone. Those with chronic inflammation (inflammation that is persistent and long-lasting) may find better, more lasting relief with physical therapy and other treatments.

Recommended Maximum Dose

There is no hard-and-fast rule about the number of cortisone shots a person can receive. But generally speaking, healthcare providers do not like giving repeated cortisone shots to the same body part again and again.

Repeated cortisone injections are simply not healthy for tissues. Over time, the shot can damage cartilage and lead to necrosis (death) of nearby bone. Because of its hormone-like effects, it can also make conditions like diabetes more difficult to manage.

To avoid this, orthopedic surgeons will generally limit the number of cortisone shots in any one space to no more than three per year.

There are exceptions to the rule. For example, if someone with severe knee arthritis is advised to delay knee replacement surgery, additional shots may be reasonable. This is because knee replacements are typically delayed for as long as possible to ensure they last for the duration of the person's life.

On the other hand, if multiple shots are needed because the pain relief is inadequate, giving additional shots will not likely be of any real benefit. If anything, the shots may cause more harm (in terms of damage to cartilage and bone) than good. Other treatments may be far more effective.

Summary

Cortisone shots are commonly used by orthopedic surgeons and other healthcare providers to reduce pain, stiffness, and swelling in a joint. The drugs work by quickly reducing the inflammation that causes pain.

As effective as cortisone shots can be, their effects are usually not permanent. Because the overuse of cortisone can damage cartilage and bone, orthopedic surgeons try to give no more than three shots per year to any body part. Exceptions can be made on a case-by-case basis if there is a serious condition in which the benefits outweigh the risks.

A Word From Verywell

People tend to like cortisone shots because they get immediate relief that can last for months. This doesn't mean, however, that the underlying condition has also improved.

With knee osteoarthritis, the damage to the joint is ongoing and doesn't stop simply because you feel no pain. In fact, because you feel good, you may place undue stress on the joint and add to the existing damage.

Because of these and other concerns, you should listen to your healthcare provider if they suggest there are better options for you than cortisone. The treatments may not provide immediate relief, but they can possibly preserve the function of your joint more effectively.