Right-handed rotation prospect Casey Kelly, 23, will likely become the fourth San Diego Padres pitcher to have elbow reconstruction surgery in the last year.
Kelly is waiting for a second opinion before committing to Tommy John surgery.
"I've prepared myself for the worst," said Kelly. "I don't have too many options. The doctors are concerned with what they saw."
Kelly, who last appeared in a spring training game on March 7, had his elbow examined by Padres team physician Heinz Hoenecke in San Diego on March 12.
Kelly said the exam showed "micro tears" in the ulnar collateral ligament in his right elbow. Tears in the UCL are treated by either prolonged rehab sessions or Tommy John surgery -- which replaces the ligament with a ligament taken from either the opposing forearm or a leg. Rehab following elbow reconstruction surgery can take between 12 and 18 months.
"It is that part of the elbow that we're concerned about," said Padres manager Bud Black. "The doctors are concerned about what the tests looked like. There's going to be a lot of discussion between Kelly and his family."
Kelly had similar elbow problems twice last year. And the problems have reappeared after each of two lengthy rehab sessions. Kelly first experienced elbow problems while with Triple-A Tucson last April and spent 3 1/2 months on the disabled list due to what was called a "right elbow strain." After a rehab assignment with Double-A San Antonio, Kelly joined the Padres on Aug. 27 and was 2-3 with a 6.21 earned run average in six starts with the Padres. But the pain in his elbow returned toward the end of the season and he was shut down before his final scheduled start. He spent the winter rehabbing the elbow a second time.
"This is not black and white," said Kelly. "If nothing had happened last year, we might not be talking about surgery now. I definitely don't want to jump into surgery, but rehab hasn't worked. The MRI (on March 12) was not much different from last year. Surgery was an option last year, but the option was to rehab the elbow. They didn't see enough last year for surgery."
Kelly said the pain in his elbow returned after his March 7 outing against the Angels. "I felt something that game," he said. "The next day it didn't recover. I want to make sure before I go ahead in any direction."
Black and Kelly agree that the damage to the elbow was cumulative and not the result of any one pitch. "This type of injury can happen on one pitch," said Black. "But I think this was more long term."
Since last May, developing staff ace Cory Luebke, Joe Wieland and minor league prospect Juan Pablo Oramas also had elbow reconstruction surgery last season. Luebke is expected to return around the All-Star break.
Kelly is regarded as one of the top three prospects in the Padres organization. Another top three prospect, right fielder Rymer Liriano, was lost for 2013 when he had Tommy John surgery three weeks ago.