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Medlen has elbow ligament damage, may avoid surgery

Pitcher set for further testing; Beachy, Minor could also hit DL to begin season

LAKE BUENA VISTA, Fla. -- Kris Medlen has not escaped the danger zone. But for now, he can at least continue hoping to avoid undergoing Tommy John elbow reconstruction surgery for the second time in four years.

When Braves doctors reviewed the results of an MRI exam performed on Monday, they saw what appears to be damage around the ulnar collateral ligament in Medlen's right elbow. But the results were somewhat inconclusive, because images of an elbow that has already been repaired by Tommy John surgery are often cloudy.

Thus Medlen was scheduled to undergo another evaluation on Tuesday in the Orlando area. Later this week, he will also likely be evaluated by Dr. James Andrews, who performed Tommy John surgery on the Braves' pitcher on Aug. 18, 2010.

"The MRI does show some involvement with the ligament," Braves general manager Frank Wren said. "We don't know the extent yet. He's going to have continued tests, and he's probably going to have a second opinion. So for us to put a complete diagnosis on it now would be premature.

"MRIs on previous Tommy John [patients] are not as clear and not as precise. I think that is why you have to do a little more evaluation."

The always accommodating and upbeat Medlen arrived at Champion Stadium early Tuesday morning with a smile on his face and the understanding that he had to be prepared to deal with whatever the results revealed. As Medlen was preparing to speak to reporters a few hours later, he was whisked away by the Braves' medical staff to undergo another evaluation.

After the MRI exam Braves left-handed reliever Jonny Venters underwent near the end of Spring Training last year, he visited Andrews, who prescribed a month's worth of rest. After Venters began throwing off a mound again in May, he felt discomfort that led him to the determination he would have to undergo a second Tommy John surgery.

While Medlen might also learn there is a chance he could avoid surgery, he will obviously be sidelined during the early portion of the regular season. The results learned over the next couple of days will provide a better understanding of just how long the Braves will be without a man who has become one of baseball's most underappreciated pitchers.

Medlen has produced a 2.46 ERA in the 43 starts he has made since becoming a mainstay in Atlanta's rotation on July 31, 2012. Clayton Kershaw (1.80) is the only other pitcher who has produced a lower ERA while making at least 40 starts during that span.

Medlen has not publicly spoken since exiting Sunday's start against the Mets with two outs in the fourth inning. The 28-year-old hurler grabbed his right elbow and walked toward second base after throwing his first pitch to Matt Clark, the final batter he faced. After throwing a wayward changeup with his next pitch, he walked directly toward the dugout before consulting with the team's medical personnel.

"I'm really hoping for the best for Kris," said Braves pitcher Brandon Beachy, who continues to encounter frustration as he attempts to return from the Tommy John surgery he underwent two years ago. "I've been through it, and I know he's been through this kind of stuff before. You just really feel for what he's going through mentally."

Less than 24 hours after having a "sickening feeling" as Medlen made his abrupt exit, Wren saw his rotation concerns grow, courtesy of the rough two-inning performance Beachy completed against the Phillies.

As Beachy threw a fastball that rested in the low 80s and touched 88 mph just once according to one National League scout, he was plagued by tightness around his right elbow and biceps. The Braves believe Beachy is simply dealing with normal soreness as he recovers from a cleanup surgery Andrews performed in September to remove a floating bone chip from his repaired elbow.

But there is obviously some reason for concern given all of the struggles Beachy endured, as he was limited to just five starts once he finally returned to the Braves' rotation 13 months after undergoing Tommy John surgery.

"These are the kinds of setbacks you have from any elbow surgery where they sometimes get a little sore. When they get a little sore, you work to get the inflammation out," Wren said. "There is no definitive timeline, because every guy is different."

It goes without saying that Atlanta's rotation plans have been altered over the past 48 hours. The Braves are now staring at the distinct possibility of beginning the season with Medlen, Beachy and Mike Minor on the disabled list.

"It's worrisome," Wren said. "We still feel like we have a good pitching staff. We 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 is going to happen. We've seen that over the last two days. Very quickly, your depth can go to a shortage. We're evaluating and we're exploring other opportunities. That is all we can do at this point."

Minor reported to Spring Training behind schedule because he was forced to remain inactive for a month following a Dec. 31 urinary tract procedure. The southpaw was shut down when he felt some left shoulder discomfort during the early days of camp. But he has thrown in a pain-free manner over the past three weeks and is still aiming to join Atlanta's rotation during the regular season's second week.

Gavin Floyd has impressed the Braves with the arm strength he has shown while attempting to return from the elbow reconstruction surgery he underwent 10 months ago. But the Braves still are not projecting him to join the rotation before the early part of May.

"We do know we have a number of guys who won't be ready on Opening Day," Wren said. "But they should be ready soon after. So as we go on that premise, that impacts who we go look at and how much of a need there is to acquire somebody else. A lot of it has to do with when we think guys will be ready."

Mark Bowman is a reporter for

Atlanta Braves, Brandon Beachy, Gavin Floyd, Kris Medlen, Mike Minor