From Jonathan Cluett, M.D.,
Your Guide to Orthopedics.
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About.com Health's Disease and Condition content is reviewed by Kate Grossman, MD

A. The short answer? It depends.

First, a bit about cortisone injections: They are used in the treatment of 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:

• Bursitis
• Tendonitis
• Trigger finger
• Carpal tunnel syndrome
• Tennis elbow
• Knee arthritis
• Many other overuse conditions...

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?

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.

So what is the bottom line?
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.