Ok first of all cuff tear is a very very very very general term as there are 4 cuff muscles.
The supraspinatus is not deep to the deltoid... I guess saying the tendon is deep might be better but its' not realyl something anyone ever says cause of where it goes.
Second, topicals only reduce pain, they do not change physiology by any means, and when they do it's very superficial. Also, the body needs inflammation for the area to heal. Anti-inflammatories longer term will impede this process from happening, they should only used for pain and acute situations.
Was there any pain in any of the muscle tests and did he do a bunch of them?
When you lift your arm your arm out to the side all the way up does it hurt?
Does it hurt lifting it forward? and where
Try this one, lift your arm up point your thumb down and then move it across your body, does that hurt and where?
My main point is that, pain in the shoulder can be caused by the neck, impingement, labrum, cuff, muscle strains ligament strains, scapula... ETC.....
Most docs are very terrible at differentiating one from the other, because they've never learned or haven't kept up to date on it. Saying cuff tear is a real half ass answer.
Sorry, deep to the deltoid in action, meaning supportive. It's palpable so not deep in terms of depth.
I have to disagree about topicals not having physiological benefit. What about transdermals? The skin absorbs.
I agree with you about shoulder pain being secondary to other things like the cervical issues, impingements, issues of the scapula, etc.
And you are SO right about most MDs not being good at musculoskeletal injuries and the reasons for that.