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Smoking is perhaps the most damaging, as it dramatically reduces blood flow to the already poorly-vascularized rotator cuff tendons

Journal of Clinical Endocrinology & Metabolism, 105 (10), 3556-3565

Flowchart outlines process for diagnosing PA and Antibody Negative PA in UK BMJ B12 article bmj.com/content/349/bmj.g5226 Emphasises need to treat patients who are symptomatic even if their B12 level is within range