The role of diagnostic nerve blocks in guiding spasticity management – application, efficacy and safety: A scoping review

Diagnostic nerve blocks (DNBs) are emerging as valuable tools for assessing and guiding spasticity management, yet their clinical application remains variable and underexplored. This scoping review systematically maps the current literature on the use, efficacy, and safety of DNBs across diverse neurological conditions. Following the PRISMA-ScR guidelines, a comprehensive search of PubMed, Embase, and Web of Science was conducted, identifying 15 studies involving 504 patients with spasticity due to stroke, cerebral palsy, spinal cord injury, traumatic brain injury, and other etiologies. DNBs were predominantly applied to the lower limbs, targeting spastic equinovarus foot and stiff knee gait. Reported outcomes included spasticity scales, joint range of motion, gait kinematics, electromyographic changes, and functional mobility tests. Across studies, DNBs consistently supported clinical decision-making including decisions on botulinum toxin dosages, neurolysis and neurectomy. Their use was also associated with improved goal attainment rates. Adverse effects were infrequent and transient. While most studies were of fair quality, limitations included small sample sizes, absence of blinding or powered calculations. Overall, DNBs represent a safe and valuable tool, enhancing diagnostic precision and facilitating personalized, patient-centered spasticity management. Future high-quality studies are needed to establish standardized protocols and strengthen the evidence for their use in clinical practice.