How many cortisone shots can you get in a lifetime?

Cortisone shots are a commonly used treatment for reducing inflammation and pain in joints and soft tissues. However, there are some concerns around the long-term use and safety of cortisone injections. So how many cortisone shots can you safely get over the course of a lifetime?

What are cortisone shots?

Cortisone shots, also known as corticosteroid injections, are anti-inflammatory medications used to treat a variety of musculoskeletal conditions. The corticosteroid medication is injected directly into a joint, tendon, or bursa to deliver high concentrations of the drug right to the source of inflammation.

Cortisone shots work by reducing inflammation that causes pain and swelling. Common conditions treated with cortisone injections include:

  • Arthritis – osteoarthritis, rheumatoid arthritis
  • Bursitis – trochanteric bursitis, olecranon bursitis
  • Tendinitis – Achilles tendinitis, patellar tendinitis
  • Carpal tunnel syndrome
  • Trigger finger
  • Plantar fasciitis
  • Gout
  • Joint injuries – sprains, fractures

The anti-inflammatory effects of the corticosteroid can provide rapid symptom relief, however the benefits are often temporary. Many patients get repeat injections to manage chronic musculoskeletal conditions.

Are there risks or side effects?

Cortisone injections are generally very safe when used sparingly. However, frequent or repetitive injections can cause complications or side effects. Potential risks include:

  • Infection – risk is small but injections do disrupt the skin barrier
  • Nerve damage – rare but possible if cortisone is injected near a nerve
  • Tendon weakening or rupture – corticosteroids may weaken collagen in tendons and ligaments
  • Cartilage breakdown – frequent injections may accelerate joint damage
  • Thinning skin or depigmentation – skin at injection site may become thin, fragile and lighter in color

There is also a risk of metabolic side effects if high doses of corticosteroids enter the bloodstream, including high blood sugar, fluid retention, and effects on the adrenal glands. However, local injections into joints and soft tissues have minimal systemic absorption or side effects compared to oral steroids.

Are there limits on how many you can get?

There are no universally agreed upon guidelines dictating a maximum lifetime number of cortisone injections. However, many experts recommend limiting shots to 3-4 per year per body part in order to minimize complications.

Some general injection frequency recommendations include:

  • Knee joint – max of 4 injections per year
  • Shoulder joint – max of 4 per year
  • Hip joint – no more than 4 per year
  • Heel – no more than 4 per year
  • Wrist – no more than 3 per year
  • Ankle joint – max of 3 per year
  • Elbow – no more than 2-3 per year
  • Trigger finger – limit to 2-3 injections

The American College of Rheumatology recommends spacing knee injections by at least 3 months and avoiding more than 4 per year. Planning adequate rest between injections allows time for tissues to heal.

What factors affect the injection limits?

There are several factors that influence recommendations for injection frequency including:

  • Type of joint – Large weight-bearing joints like the knee can tolerate more frequent injections than smaller joints.
  • Severity of arthritis – More damaged joints may need more frequent shots for symptomatic relief.
  • Type of corticosteroid – Longer acting preparations last longer but may have higher complication risks.
  • Combination injections – Adding anesthetics may allow lower doses of corticosteroids.
  • Rest intervals – Adequate rest between injections reduces risks.
  • Activity level – The more active the joint, the higher the risk of complications.

Doctors also take into account patient factors like age, weight, medications, and other medical conditions when planning cortisone injections.

What are alternatives to frequent cortisone shots?

There are several alternatives to consider if cortisone injections are needed more than 3-4 times per year:

  • Oral anti-inflammatory medications – NSAIDs, analgesics, disease-modifying antirheumatic drugs (DMARDs)
  • Physical therapy – Strengthening exercises may reduce need for injections
  • Braces or assistive devices – May help take pressure off inflamed joints
  • Lifestyle changes – Weight loss, activity modification, proper footwear
  • Surgery – Joint replacement, repair, or arthroscopic procedures
  • Alternative injections – Hyaluronic acid, platelet-rich plasma (PRP)

Complementary treatments like massage, acupuncture, heat/cold therapy may also help reduce inflammation and pain between injections.

What are the long-term effects?

Most of the risks and side effects of cortisone shots relate to frequent repeated injections. Potential long-term effects include:

  • Accelerated joint damage – Increased cartilage breakdown, faster arthritis progression
  • Chronic pain – Repeated shots may lead to worsening pain due to complications
  • Tendon weakness – Increased risk of tendon rupture or detachment
  • Thinned skin – Skin may become atrophic and fragile at injection sites
  • Nerve injury – Rare but injections may cause nerve damage
  • Infection – The more injections, the higher the infection risk

There is still debate over whether frequent cortisone shots actually worsen joint arthritis. But most experts agree that shots do not address the underlying condition and joint damage may progress despite temporary pain relief from injections.

Does the injection site matter?

Yes, the specific joint or area injected can influence the risk of side effects and complications:

  • Weight-bearing joints – Hips and knees tolerate more injections than hands or feet
  • Smaller joints – Fingers, toes, elbows, ankles are more prone to complications
  • Superficial tissues – Bursae, tendons have higher risk than intra-articular joints
  • Areas that stretch – Plantar fascia, Achilles tendon are vulnerable to weakening

In general, larger stronger joints like the shoulder and knee can safely receive more frequent injections than smaller more fragile joints. Injections into tendons and bursae also carry higher risks compared to intra-articular joint injections.

Does the condition being treated matter?

Yes, the underlying condition can also impact recommendations for cortisone injection frequency including:

  • Acute vs chronic condition – Acute injuries may need only 1-2 shots, chronic conditions require more
  • Severity of symptoms – Worse symptoms may mean more shots to control pain/inflammation
  • Nature of inflammation – Some conditions respond better than others to steroids
  • Amount of joint damage – Severely damaged joints may get more shots for relief

For acute injuries like sports sprains, 1-3 cortisone injections may be used along with a short steroid taper. But chronic degenerative arthritis often requires shots every 3-6 months to manage recurring inflammation and pain.

What are the signs it may be time to stop injections?

Signs that it may be time to stop cortisone injections in a particular body area include:

  • No improvement in symptoms or pain relief
  • Increasing frequency of injections needed
  • Worsening pain or new symptoms develop
  • Skin around injection site becomes thin, pale or tender
  • Joint stability deteriorates or popping/catching increases
  • Decreased range of motion after injections

If any complications occur or injections stop providing lasting relief, discuss alternative treatment options with your doctor. Surgery, alternative injectables, or pain management strategies may be needed.

Summary

  • There are no strict lifetime limits on the number of cortisone injections, but guidelines recommend 3-4 per year in a single body part
  • Small joints and tendons should not get as many injections as larger sturdy joints
  • Allowing adequate rest periods between injections reduces risks
  • If frequent ongoing injections are needed, explore alternative treatments to avoid side effects
  • Carefully weigh the benefits against potential risks and complications
  • Work closely with your doctor to determine appropriate injection frequency for your condition

Conclusion

While there are no absolute limits, most experts advise restricting cortisone injections to fewer than 4 per year in any single joint or area. Higher frequencies increase the risks of complications and long-term effects. The number of injections should be tailored to the individual based on factors like the joint involved, type of injury or arthritis, severity of symptoms, and response to the injections. Close monitoring and follow-up care are important when getting repeated cortisone shots to avoid potential complications. If excessive injections are needed, explore alternative treatment options with your doctor to find the most effective approach with the least risk.

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