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Common symptoms include: Shoulder pain with overhead activities or reaching behind the back Night pain, especially when lying on the affected side Weakness in lifting or rotating the arm Clicking or popping sensations during movement Stiffness or loss of range of motion If left untreated, tendinopathy can progress to partial or full-thickness tendon tears and contribute to chronic shoulder instability

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Low B12 status (200–300 pg/mL) without obvious symptoms affects up to 40% in Western populations [10]