In Hawai'i, where a majority of athletes participate in sports requiring use of their upper bodies — including weightlifting, water sports such as swimming, paddling and surfing, and basketball, baseball, golf and tennis — shoulders tend to be healthy.

"Hawai'i has a high percentage of upper-extremity dependent athletes," Dr. Edward J. Weldon, III, MD, said. "In my experiences (he's also worked in Boston, San Antonio, Seattle, and Sacramento, Calif.), Hawai'i has the healthiest shoulders that I've ever seen. It's quite remarkable."

It doesn't mean athletes here don't suffer shoulder injuries or pain. One common source of shoulder pain is capsulitis, or the inflammation of the circumferential ligament, the capsule that surrounds and connects the ball to the socket.

Capsulitis, or inflammation of the shoulder, also is called frozen shoulder, stiff shoulder, or adhesive capsulitis.

A majority of shoulder problems that Weldon sees in his clinic at Straub can be treated without surgery.

"Almost all capsulitis can be treated nonoperatively," he said. "The vast majority of shoulder problems involve capsulitis."

Other shoulder injuries, such as rotator cuff tears, dislocation, arthritis, instability or fractures, can lead to capsulitis.

Capsulitis leads to shoulder stiffness. Unless the stiffness is addressed, the capsulitis — and pain — will continue.

Stiffness can hinder your athletic performance. Most sports benefit from having a loose shoulder, according to Weldon.

Four-quadrant stretching (see graphic, below), which targets the front and back, and upper and lower sections of the shoulder, is a solution to shoulder stiffness.

Stretching can help remedy capsulitis, but also works as a good way to keep your shoulder healthy and strong before injury, and achieve a higher level of athletic performance.

Reach Leila Wai at lwai@honoluluadvertiser.com.