Is it dangerous to have too many cortisone injections?

Yes, beyond 3 to 4 injections per year on the same joint, risks increase: tissue atrophy, tendon rupture, bone necrosis, and cartilage thinning. Dr Bolduc rigorously follows these guidelines.

Can PRP completely replace cortisone?

PRP is an excellent alternative for chronic tendinopathies and partial tears, but it is not always suitable in acute phases where inflammation is severe. Cortisone remains more effective for acute inflammatory flare-ups.

How much does a PRP injection cost in Quebec?

PRP is not covered by RAMQ. The cost typically ranges from $300 to $600 per injection depending on the clinic and number of sites treated.

What if cortisone stops working after several injections?

It is time to explore other options such as PRP, shockwave therapy, targeted physiotherapy, or as a last resort, surgical consultation. A complete reassessment is necessary.

How Many Injections Can You Safely Have?

Injections: A Valuable Tool to Use Wisely

Injections are among the most effective treatments for inflammatory musculoskeletal conditions. At the Clinique de médecine musculo-squelettique at 8131 boul. Cousineau, Saint-Hubert, Dr Sébastien Bolduc uses ultrasound-guided injections daily to precisely treat tendinitis, bursitis, and other joint conditions. But one question comes up constantly: how many injections can you safely receive? Here is everything you need to know.

Cortisone Limits

Cortisone is a powerful anti-inflammatory that works directly at the inflammation site. While effective, it is not without risks when used repeatedly. The general recommendation is not to exceed 3 to 4 cortisone injections per year on the same joint. Beyond that, the risk of complications increases significantly.

Risks of excessive cortisone use include: atrophy of surrounding soft tissues, tendon weakening that can lead to spontaneous rupture, bone necrosis (osteonecrosis), thinning of articular cartilage, and delayed tissue healing. This is why Dr Bolduc always uses the minimum effective dose and spaces injections at least 6 to 8 weeks apart.

PRP vs Cortisone for Repeat Treatments

Platelet-rich plasma (PRP) is an excellent alternative when cortisone reaches its limits. Unlike cortisone which suppresses inflammation, PRP stimulates tissue repair. It can be repeated more frequently (2 to 3 series per year) with fewer side effect risks. PRP is particularly indicated for chronic tendinopathies and partial rotator cuff tears.

However, PRP has a drawback: it is not covered by RAMQ and costs more than a cortisone injection. Additionally, its effect is less immediate — results typically appear after 4 to 6 weeks, compared to cortisone which works within 24 to 48 hours.

Signs That Injections Are No Longer Working

If you notice that the effect of your injections lasts less and less time, or if the pain returns more intense than before, it is time to reconsider the therapeutic approach. Other signs include needing higher doses to achieve the same effect or the appearance of pain in a different area after the injection.

Alternatives When Injections Are No Longer Enough

When injections reach their limits, several options are available. Shockwave therapy is particularly effective for calcific tendinopathies and fasciitis. Intensive physiotherapy with a personalized rehabilitation program can strengthen weakened structures. In some cases, surgery may be discussed, but this is generally the last resort option. Dr Sébastien Bolduc evaluates each case individually to recommend the best strategy.