Navigating rare terrain: successful management of subscapular and deltoid hematomas via the dorsal scapular approach.

Subscapular hematomas are rare entities that pose diagnostic and therapeutic challenges due to their deep anatomical location and nonspecific presentation. Delayed recognition may lead to abscess formation and long-term functional impairment. We report the case of an 18-year-old male who presented with progressive pain, swelling, and restricted range of motion of the right shoulder following blunt trauma. Imaging revealed a large subscapularis hematoma with an associated smaller intramuscular deltoid hematoma. The patient underwent expedited surgical evacuation using a modified dorsal scapular approach with two incisions, allowing safe and effective drainage while preserving surrounding neurovascular structures. A total of 450 ml of hematoma was evacuated. Postoperatively, inflammatory markers declined, pain resolved, and shoulder range of motion improved substantially with physiotherapy. No complications were observed during follow-up. This case highlights the importance of early diagnosis and supports the dorsal scapular approach as a safe and effective option for managing deep periscapular hematomas.