Shoulder strain sends Garcia to disabled list

ST. LOUIS -- A week after losing one member of its rotation to an arm injury, the Cardinals are now down another.

Jaime Garcia, who has been bothered by an increasing amount of shoulder discomfort over the past two weeks, has been placed on the 15-day disabled list with a left shoulder strain. But unlike Jake Westbrook -- who is expected to only miss three starts as he recovers from an elbow injury -- Garcia is bracing for the possibility that his absence could be much longer.

Garcia will receive treatment recommendations from the Cardinals' medical staff, as well as Dr. James Andrews, who Garcia is scheduled to go see early next week. But because this injury is related to the same shoulder impingement that began bothering him 12 months ago, there is growing concern that surgery may be the necessary recourse.

"Anytime you're putting someone on the DL, there's concern," general manager John Mozeliak said. "But in this case, it's not like the Westbrook example when you feel pretty optimistic he's only going to miss a couple starts. This one doesn't read like that. But I'm not going to tell you what it reads like for sure until I circle with our doctors and get a better feel for it. All indications seem like it's not good."

This same injury sidelined Garcia for a little more than two months last summer and then forced him off the playoff roster in October. At that time, Garcia considered addressing the issue with surgery before eventually deciding to try a rehab course instead.

Garcia reported to Spring Training with no limitations and made his first five starts of the season without any discomfort. Though he pitched eight strong innings in a win against the Brewers on May 5, it was that day, Garcia said, that he first felt something wrong in his shoulder.

Garcia made two more starts -- including one Friday night in which he allowed six runs in 5 1/3 innings -- before it was determined that he could no longer pitch.

"I would say at this point it's worse," Garcia said when asked how the discomfort compared to what he dealt with last year. "There's a lot more pain than last year. It started three starts ago. I was feeling great up until that point. I basically tried to take care of doing little things here and there and it went downhill, getting worse and worse."

The pain was debilitating enough on certain pitches he made Friday night that Garcia considered pulling himself out of the game. On Saturday, he said it hurt to lift up his left arm.

"I don't think I've ever done that in my career, where I've come out after a pitch, but I was real close," he said. "To be honest with you, I don't know how I made it through. It's a tough thing for me. I worked so hard this offseason. I really want to be out there for my team. Just to basically give up is a hard thing for me to do. But I'm at a point where I had to say something about it."

An MRI taken on Garcia's shoulder indicated that he is dealing with the same structural issue that he had last season. The Cardinals should know next week whether Garcia will need to go the surgical route to correct the problem.

"I'm very concerned," Garcia said, "especially with the way I felt last night and the way I feel today."

Mozeliak said that he and manager Mike Matheny will make a determination no later than Monday as to who will take Garcia's place in the rotation. Garcia's spot is scheduled to come up next on Wednesday.

The Cardinals have several moving pieces to consider as they reshuffle the rotation. Though Westbrook is still working through his own rehab, he is expected back the last week of May. Chris Carpenter continues to make progress in his throwing program, too, which could make him a rotation option as early as June.

In the meantime, as the Cardinals look for a short-term fill-in, they will consider pitchers on the Major League roster and in Triple-A.

Relievers Seth Maness, Carlos Martinez and Joe Kelly all have extensive starting experience. Because he has been pitching in relief since the start of the season, Kelly does not likely have the arm strength built up to immediately slide into a starting role. Maness and Martinez are not as far removed from starting, though the Cardinals will also have to consider how their arms would respond to a sudden increase in workload.

If the Cardinals dip down into their depth, Triple-A lefty Tyler Lyons and right-hander Michael Wacha will get consideration.