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Cortisone | Steroid | Injection | How Often
How many or how often can I have a cortisone injection? This is a common question asked by patients. Some patients believe they can only ever have one injection in a joint ever! This just isn’t true but there are some rules when it comes to the number of injections that are felt to be safe. In order to discuss this issue there are a number of questions that should be answered.
Did the injection work?
If a cortisone injection provides absolutely no relief then it is of no use to keep repeating the injection. If the injection provides only a few days to a week or two of pain relief then the effect is probably not good enough. You’re looking for relief that lasts a month or two and hopefully up to three months. Some patients have even longer lasting relief. If the injection works well then that is the first step for considering a repeat injection.
What is the situation and what are the other options?
To answer this question we’ll pose a couple of different scenarios. Imagine an 85-year-old patient with severe knee arthritis who is not a candidate for knee replacement surgery. The patient receives receives significant relief from a knee injection lasting a month or two. In this scenario, given the limited treatment options, it is reasonable to continue with repeat steroid injections.
The second patient is a 29-year-old patient with shoulder pain who finds relief from a steroid injection for rotator cuff tendonitis. Through investigations there are no other shoulder problems and the rotator cuff tendons are intact. In this scenario we would worry that repeated steroid injections could weaken the tendons and cause future problems. In this scenario, physiotherapy would be a more appropriate alternative.
If repeat injections are appropriate, how often?
This is another good question. There is no good answer to this but common sense always prevails! A good rule of thumb is no more than 2-4 injections into a single joint in a year. An article published in 2003 (Arthritis Rheum. 2003 Feb;48(2):370-7) took patients with osteoarthritis of the knee and performed steroid injections every 3 months for 2 years. At the end of 2 years there was no structural damage to the injected knees compared to knees which were not injected. Furthermore, long-term treatment of knee OA with repeated steroid injections appeared to be clinically effective for the relief of symptoms of the disease.
Injections and Joint Surgery
We’ll end with a word of caution. We don’t like to perform steroid injections within 3-months of joint surgery. This increases the risk of infection following the joint surgery.