LAKE BUENA VISTA, Fla. – A magnetic resonance imaging (MRI) exam on Kris Medlen’s injured elbow showed “some involvement in the ligament,” Braves general manager Frank Wren said, and the pitcher will have further tests and a second evaluation before determining whether he needs surgery.
Medlen, who had ligament-transplant elbow surgery -- aka Tommy John surgery -- in 2010 and missed most of the 2011 season for a 13-month rehab, left Sunday’s game against the Mets after grabbing his right elbow and hopping off the mound in pain following a fourth-inning pitch. The injury was intially diagnosed as forearm strain, but an MRI on Monday showed apparent ligament damage.
A day later, Braves starter Brandon Beachy lasted only two innings of a planned four-inning appearance because of biceps tightness. He's coming back from two elbow surgeries in a 15-month span. Braves starter Mike Minor is also questionable for the first two weeks of the season after having shoulder soreness in the first week of camp.
With the injuries mounting, the Braves are looking at possible additions to their rotation, including checking into still-unsigned free agent Ervin Santana.
“In this job, there’s a reason why – I know you guys get tired of hearing it, the fans get tired of hearing it – that we say we like our team if we can stay healthy," Wren said. "We like our team just assuming health. It’s sometimes a very fragile position that you sit in when you have a good team, a lot of times you can’t weather a lot of injuries. And when you see a guy like Kris Medlen, who’s been such a good performer for us … when you see him walk off the mound you get a sick feeling in your stomach. Not unlike when you see Tim Hudson get stepped on at first base (in 2013), on a routine play.
“Things happen. You can’t control them, nothing you can do about them, it’s just the nature of the business that we’re in. But that (Medlen injury) is a tough one to watch.”
Medlen met with Braves doctors Tuesday to discuss the situation, then left Champion Stadium without speaking to reporters because he had to get to another medical appointment, a team spokesperson said. He's expected to consult with Dr. James Andrews, his 2010 surgeon, at some point this week.
If Medlen needs another Tommy John surgery, he would join Braves reliever Jonny Venters in trying to be among the few pitchers to ever come back from two "TJ" surgeries and perform at a high level again in the majors.
MRIs on patients who previously had Tommy John surgery can be difficult to read because of the scarring in the area of the previous procedure, and the doctor who did the surgery is usually consulted when there are subsequent injuries. Andrews did the TJ surgeries on Medlen, Beachy and Venters (twice).
"The MRI does show some involvement in the ligament. We don’t know the extent yet," Wren said. "He’s going to have continued tests. He’s also going to probably have a second opinion and take a look at it. So for us to put a complete diagnosis on it at this time would be premature. So we’re going to let this process kind of work its way through over the next few days.”
The Braves’ list of health issues with starting pitchers continues to grow. Wren didn't specify who they might try to add via trade or free-agent signing, but they are known to have checked Monday with Santana, who had a 3.24 ERA and 161 strikeouts in 211 innings last season for the Royals.
“It’s worrisome, let’s put it that way," Wren said of the recent pitching injuries. "We still feel like we have the makings of a very good pitching staff, but you need depth at this level, because you just never know what’s going to happen. We’ve seen that over the last two days, how your depth can go to a shortage. And so we’re evaluating, we’re exploring other opportunities, and that’s all we can do at this point.”
But with Minor and Floyd expected back in April and May, respectively, and Beachy's current issue not believed to be serious, the Braves might opt to go with a cheaper, temporary fill-in option rather than spend $14 million or more for Santana, who reportedly has offers worth about that much on the table from the Orioles and Blue Jays.
“There’s a domino effect of guys that will be ready, but are not going to be ready opening day; they’ll be ready shortly thereafter," Wren said of the Braves' rehabbing pitchers. "So as we go on that premise, that impacts who we go out and look at, how much of a need we think there is in acquiring someone else – we have to factor everything in.”
Beachy left Monday's start against the Phillies after only two innings, but said he wasn't at all worried about the injury and that it was typical soreness for someone coming back from surgery (he had Tommy John surgery in 2012 and an arthroscopic procedure in September to remove a bone chip). Wren said much the same thing Tuesday about Beachy, and echoed what the pitcher said about probably not needing an MRI.
Minor wasn't able to throw in January following urinary-tract surgery Dec. 31, then developed shoulder soreness after doing a bit too much too soon when camp opened in February. He could get in a Grapefruit League game within a week, and the Braves are holding out hope that he could avoid a season-opening stint on the 15-day disabled list and be ready to pitch by April 12, the first day the Braves would need a fifth starter (off days in the early schedule would permit them to go with four starters on regular rest until then).
But the potential loss of Medlen for the season could be a blow the Braves have a hard time overcoming. He was scheduled to start opening day and had been their best starter since moving from the bullpen in late July 2012, going 24-12 with a 2.47 ERA in 44 games (43 starts) since then. His 2.40 ERA since the 2012 All-Star break is the second-best in baseball among pitchers with at least 250 innings, behind Dodgers ace Clayton Kershaw.
Andrews has previously placed the success rate at about 20 percent for pitchers to return to pre-surgery form after a second Tommy John surgery, and the percentage has been much better for relievers than for starters.