CRPS-Hand: Contrast + Compression vs Whirlpool

Combined Contrast Therapy and Intermittent Compression vs Whirlpool Therapy in Post-Traumatic Hand and Wrist CRPS: A Randomized Controlled Trial

This randomized controlled trial aims to evaluate and compare the effectiveness of combined contrast therapy with intermittent compression and whirlpool therapy in patients with post-traumatic CRPS-I of the hand and wrist, using objective outcome measures of pain, edema, and functional status.

Study Overview

• Status: Recruiting
• Conditions: Complex Regional Pain Syndrome I (CRPS I)
• Intervention / Treatment: Device: Combined Contrast Therapy with Intermittent Compression; Device: Whirlpool Therapy

Detailed Description

Complex Regional Pain Syndrome Type 1 (CRPS-I) is a condition that may develop after upper extremity trauma, surgical interventions, or central nervous system disorders, leading to chronic pain and functional impairment. Hydrotherapy modalities such as whirlpool and contrast bath therapy are commonly used; however, comparative evidence with combined thermal and compression-based systems remains limited.

Combined contrast therapy with intermittent compression is a non-invasive intervention delivered using the Game Ready MED4 Elite device, which integrates thermal therapy (cold-warm) with intermittent pneumatic compression (IPC). Evidence, particularly from postoperative orthopedic settings, suggests that this approach may reduce pain and edema and promote functional recovery. Cryotherapy reduces inflammation and vascular permeability, thermotherapy promotes vasodilation and tissue relaxation, and intermittent pneumatic compression (IPC) enhances venous and lymphatic return, supporting regional circulation.

The whirlpool method is a commonly used adjunctive physical therapy modality in CRPS-I treatment, involving immersion of the affected extremity in circulating water at 38-40°C. This technique provides both thermal and mechanical stimulation, promoting regional circulation, reducing muscle spasm, and facilitating edema drainage. Additionally, the gentle massaging effect of water turbulence may contribute to pain modulation and tissue relaxation.

• Study Type: Interventional
• Enrollment (Estimated): 50
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Gizem Suna Tuncer, MD, Specialist Physician; Phone Number: +905347953185; Email: sunagizem05@gmail.com

Study Locations

• Turkey (Türkiye)
  • Yenimahalle
    • Ankara, Yenimahalle, Turkey (Türkiye), 06370
      • Recruiting
      • Etlik City Hospital, Department of Physical Medicine and Rehabilitation
      • Contact: Gizem Suna Tuncer, M.D; Phone Number: +905347953185; Email: sunagizem05@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Patients diagnosed with Complex Regional Pain Syndrome Type 1 (CRPS-I) according to the Budapest Criteria
• Age between 18 and 80 years
• CRPS developed following upper extremity trauma (e.g., hand or wrist fracture, soft tissue injury)
• Symptom duration less than 3 months (subacute stage)
• Ability and willingness to provide written informed consent and voluntarily participate in the study

Exclusion Criteria:

• Patients diagnosed with Complex Regional Pain Syndrome Type 2 (CRPS-II) or with evidence of peripheral nerve injury
• History of peripheral neuropathy, Raynaud's phenomenon, or vascular circulation disorders
• Presence of impaired skin integrity, open wounds, infection, or dermatological disease in the affected area
• History of cold or heat intolerance, cold urticaria, or hypersensitivity to thermal modalities
• Active infection or severe edema in the affected extremity
• Presence of serious systemic diseases (cardiovascular, pulmonary, renal, or neurological)
• Receipt of similar physical therapy or modality-based treatment within the past 3 months

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Combined Contrast Therapy with Intermittent Compression; Participants in this group will receive combined contrast therapy with intermittent pneumatic compression in addition to a standardized exercise program. The intervention will be delivered over a 3-week period (5 sessions/week, 15 sessions in total). Combined contrast therapy will integrate alternating hot and cold thermal therapy with intermittent pneumatic compression. The standardized exercise program will include supervised range-of-motion, stretching, and upper extremity mobility exercises targeting the wrist and hand.	Device: Combined Contrast Therapy with Intermittent Compression; This non-invasive intervention will be delivered using the Game Ready MED4 Elite device, which integrates thermal therapy (hot-cold) with intermittent pneumatic compression (IPC). The device is capable of simultaneously providing contrast therapy and intermittent pneumatic compression and is widely used in upper and lower extremity rehabilitation. Rapid Contrast Therapy Protocol: Heat application: Applied at 39 °C for 3 minutes Cold application: Applied at 15 °C for 1 minute, with mild compression during the cold phase Cycle duration: The heat-cold cycle will be repeated continuously for a total of 15 minutes; Other Names: Game Ready System; Cold and Compression Therapy
Active Comparator: Whirlpool Therapy; Participants in this group will receive whirlpool therapy along with a standardized exercise program. The intervention will be administered over a 3-week period, 5 sessions per week, for a total of 15 sessions. Whirlpool therapy will be applied by immersing the affected hand and wrist in circulating water maintained at 40 °C, providing both thermal and mechanical stimulation. The standardized exercise program will include supervised range-of-motion, stretching, and upper extremity mobility exercises targeting the wrist and hand.	Device: Whirlpool Therapy; Whirlpool therapy is a hydrotherapy modality used to enhance circulation in the upper extremity, reduce muscle spasm, alleviate pain, and facilitate edema resolution. In this study, a Technomex® whirlpool device will be used for hydrotherapy applications. The water temperature will be set at 40 °C and continuously monitored with a thermometer. The device motor will generate a circular turbulent water flow. The patient's hand and wrist will be positioned comfortably in the tank without compromising circulation. The duration of each session will be 15 minutes.; Other Names: Hydrotherapy; Technomex Whirlpool Device

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Visual Analog Scale (VAS)	Patients rate their pain on a 0-10 scale. A lower score indicates reduced pain.	At baseline, at 3 weeks (end of treatment), and at 7 weeks (follow-up).

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Hand Function (QuickDASH)	The Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire is a brief and practical tool used to assess upper extremity functional status and its impact on daily activities. It is the short form of the original DASH questionnaire and consists of 11 items. Participants rate their difficulty in performing daily activities involving the arm, shoulder, and hand using a 5-point Likert scale. Scores are standardized on a 0-100 scale, where 0 indicates no disability and 100 indicates the highest level of disability.	At baseline, at 3 weeks (end of treatment), and at 7 weeks (follow-up).
Neuropathic Pain Assessment (LANSS)	Neuropathic pain will be evaluated using the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scale. This tool assesses pain characteristics and sensory dysfunction through a combination of patient-reported symptoms and clinical examination findings. The total score ranges from 0 to 24, with scores ≥12 suggesting the presence of neuropathic pain.	at baseline, at 3 weeks (end of treatment), and at 7 weeks (follow-up)
Edema Measurement (Circumferential Measurement)	Edema will be assessed using circumferential measurements with a measuring tape at the wrist and palm. Wrist circumference will be measured just proximal to the distal radioulnar joint, and palm circumference will be measured at the widest level across the metacarpal heads. Measurements will be performed with the patient in a relaxed sitting or standing position, with the hand and wrist in a neutral position and the limb supported to avoid muscle contraction. The tape will be applied gently without compression. Two to three measurements will be taken at each site, and the average value will be recorded.	at baseline, at 3 weeks (end of treatment), and at 7 weeks (follow-up)
Range of Motion (ROM) and Finger-to-Palm Crease Distance (FT-PCD)	Wrist range of motion will be assessed by measuring wrist flexion and extension using a standard hand goniometer. The patient will be positioned in sitting with the shoulder in neutral position, the elbow at 90° flexion, the forearm in neutral rotation, and the wrist in a neutral position. Each movement will be measured 2-3 times, and the average value will be recorded.	At baseline, at 3 weeks (end of treatment), and at 7 weeks (follow-up)
Hand Grip Strength (HGS)	Hand grip strength will be measured using a Jamar hand dynamometer (Jamar, USA) in accordance with the standardized position recommended by the American Society of Hand Therapists. Participants will be seated with the shoulder in adduction and neutral rotation, the elbow at 90° flexion, the forearm in neutral position, and the wrist in a neutral position. Three measurements will be performed for each participant with a 1-minute rest interval between trials, and the average value will be recorded. Grip strength will be expressed in kilograms-force (kgf).	at baseline, at 3 weeks (end of treatment), and at 7 weeks (follow-up)
Finger-to-Palm Crease Distance (FT-PCD)	Finger-to-palm crease distance (FT-PCD) will be measured in centimeters as the distance between the tip of the third finger and the distal palmar crease. This measurement will be used to quantitatively assess limitations in finger flexion associated with edema and joint stiffness.	At baseline, at 3 weeks (end of treatment), and at 7 weeks (follow-up)

Collaborators and Investigators

• Sponsor: Ankara Etlik City Hospital
• Investigators: Principal Investigator: Gizem Suna Tuncer, MD, Specialist Physician, Ankara Etlik City Hospital

Study record dates

Study Major Dates

• Study Start (Actual): May 1, 2026
• Primary Completion (Estimated): April 30, 2027
• Study Completion (Estimated): July 30, 2027

Study Registration Dates

• First Submitted: July 19, 2026
• First Submitted That Met QC Criteria: August 1, 2026
• First Posted (Actual): August 4, 2026

Study Record Updates

• Last Update Posted (Actual): August 4, 2026
• Last Update Submitted That Met QC Criteria: August 1, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: Intermittent Pneumatic Compression; Complex Regional Pain Syndrome; Hand Rehabilitation; Contrast Therapy; Whirlpool Therapy
• Additional Relevant MeSH Terms: Nervous System Diseases; Neuromuscular Diseases; Peripheral Nervous System Diseases; Autonomic Nervous System Diseases; Complex Regional Pain Syndromes; Therapeutics; Physical Therapy Modalities; Rehabilitation; Hydrotherapy
• Other Study ID Numbers: AESH-EK-2026-063

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No