How often can a patient get a cortisone (corticosteroid) injection?

Frequency of Cortisone (Corticosteroid) Injections

For intra-articular and soft tissue corticosteroid injections, the recommended frequency is no more than one injection every 3 months (12 weeks) into the same joint or anatomical site, with a maximum of 3-4 injections per year. 1, 2

Standard Frequency Guidelines

Minimum Interval Between Injections

• Wait at least 6 weeks between injections into the same joint or soft tissue structure, though 3-month intervals are preferred for optimal safety 2
• Repeated injections at 3-month intervals have been demonstrated safe and effective for up to 2 years without detectable joint space narrowing 1
• The FDA labeling for triamcinolone acetonide indicates that "in recurrent or chronic conditions, repeated injections may be necessary" but does not specify exact intervals, emphasizing individualization 3

Maximum Annual Injections

• Limit to 3-4 injections per year into the same anatomical location to minimize risk of cartilage damage and progressive joint destruction 2
• This recommendation balances therapeutic benefit against potential cumulative adverse effects including cartilage injury, tendon rupture, and osseous damage 4

Site-Specific Considerations

Large Joints (Shoulder, Hip, Knee)

• Single injections are frequently sufficient, though multiple injections may be needed for adequate symptom relief 3
• For knee osteoarthritis, triamcinolone 40 mg provides equivalent efficacy to 80 mg, supporting use of lower effective doses 5
• Hip injections commonly use 40 mg triamcinolone or methylprednisolone 5

Small Joints and Soft Tissues

• Smaller joints and bursal structures typically require 2.5-15 mg per injection 3
• For conditions like trigger finger or de Quervain tenosynovitis, evidence supports corticosteroid injection efficacy, though frequency should still follow the 3-month guideline 6

Important Safety Caveats

Absolute Contraindications

• Do not inject in the presence of superficial or deep infection, fracture, or prosthetic joint 4
• Infection must be ruled out prior to any corticosteroid injection 2

Relative Contraindications and Warnings

• Avoid repeated injections for lateral epicondylosis (tennis elbow), as strong evidence indicates corticosteroids worsen long-term outcomes in this condition 6
• Exercise caution with repeated injections due to risks of tendon rupture, particularly in weight-bearing tendons 4
• Monitor for accelerated osteoarthritis progression with frequent intra-articular injections 4

Systemic Effects Requiring Monitoring

• Adrenal suppression can occur even from local injections, particularly with repeated use 4, 5
• Hyperglycemia risk necessitates close monitoring in diabetic patients 4
• Facial flushing is a common systemic side effect 1, 4
• Postinjection flare occurs commonly and should be distinguished from infection 1, 4

Clinical Pearls

Optimizing Injection Efficacy

• Ultrasound guidance increases injection accuracy and reduces procedural pain compared to landmark-guided techniques 5
• Accuracy of injection directly affects outcomes—missing the target structure reduces therapeutic benefit 1
• Use strict aseptic technique to prevent iatrogenic septic arthritis 2

Dose Optimization

• Lower doses are often as effective as higher doses: 20 mg triamcinolone equals 40 mg for shoulder injections 5
• Recommended doses are generally lower than those historically used by many clinicians 5
• For methylprednisolone acetate, doses range from 4-30 mg for tendinous/bursal structures and 40-120 mg for systemic effects 7

Duration of Effect

• Most patients experience short-term pain relief lasting weeks to months 5
• Triamcinolone hexacetonide provides the longest duration (mean of several months) but carries higher risk of tissue necrosis if injected outside synovial cavities 2
• Single injections may provide symptom relief throughout an entire pollen season for allergic conditions 3

Lack of Long-term Guidelines

• Current evidence lacks definitive guidelines on maximal lifetime corticosteroid injection use 4
• Further research is needed regarding long-term complications of continuous corticosteroid use, particularly osseous effects 4
• The 3-4 injections per year recommendation represents expert consensus based on balancing known benefits against documented risks 2