ANAHEIM -- Getting hit on the left elbow with a 99-mph fastball was painful enough for Jose Altuve, but getting hit in the same spot twice in one week is on another level.
The Astros second baseman stayed in Saturday night's 8-3 win over the Angels after getting plunked by Angels reliever Justin Anderson in the seventh inning, but he's questionable for Sunday's finale at Angel Stadium.
"It's always tough when a guy gets hit like that. You go out there and immediately see seams on his arm," Astros manager AJ Hinch said. "He's going to be sore. I don't know if he's going to play tomorrow or not. We left him in there, he had another at-bat, took another good swing, but he'll be stiff tonight."
The pitch landed on the same spot Altuve was hit in the final plate appearance of his one-game rehab assignment with Triple-A Fresno. Altuve said he thought he could play on Sunday, but conceded that the decision was up to Hinch.
"Tomorrow, I'm going to use an elbow guard," Altuve said. "Sometimes I do, but forget. In this one, I forgot."
Altuve's plunking led to two more hit-by-pitches, and two ejections in the ninth inning. Astros reliever Roberto Osuna hit Angels phenom Shohei Ohtani in the back with a first-pitch fastball with two out and nobody on in the eighth inning, triggering warnings for both dugouts from home-plate umpire Bruce Dreckman.
"I would like to not think it was on purpose. I'm not sure about that," said Ohtani. "We hit their guy, but I'm sure that wasn't on purpose. Hit by pitches are just part of baseball. It happens. I'm not thinking too much into it."

In the ninth, Angels reliever William McGuire hit Yuli Gurriel on the left leg with a 93-mph fastball on a 1-1 pitch. He and manager Mike Scioscia were ejected.
"When warnings are put in place, there's very small margin for error," Hinch said. "Their guy made a bad mistake at a time where, unintentional or not, mistakes are a little bit higher when warnings are issued. That's how the game is played."
Scioscia said the Angels weren't trying to hit either player.
"Bruce Dreckman put in a warning after they threw behind [Ohtani], and unfortunately, we were caught in a situation where Deck tries to run a sinker in to Gurriel and gets it too far in and hits him on the thigh," Scioscia said. "I can only speak from what we were doing. There was no intent. Nobody likes to see anybody get hit. Justin was certainly not trying to hit Altuve. And I know that Deck was not trying to hit Gurriel. I can speak for what happened on our side. It's unfortunate, but that's a tough situation."
Added McGuire: "It's unfortunate in that situation that warnings had been issued because there was no intent on my part. Just trying to get a guy out and have a clean inning."