Keynan Middleton to receive second opinion on forearm strain

Cardinals right-hander Keynan Middleton is set to receive a second opinion regarding his strained forearm, manager Oliver Marmol told reporters (including MLB.com’s John Denton) Saturday. 

Denton added earlier Sunday that Middleton is set to travel to New York to receive a second opinion from Yankees physician Dr. Christian Ahmad on Monday. Denton notes that the business website describes Ahmad as an “expert” on Tommy John surgery.

That’s an ominous update regarding Middleton, who the Cardinals signed as a key piece of their setup mix this year but has yet to pitch a regular-season inning in a Cardinals uniform due to the injury that sidelined him during spring training. 

The 30-year-old seemed to be nearing a return in mid-May but the Cardinals relayed last week that he had suffered a setback and that the club was now concerned about damage to his ulnar collateral ligament. 

Surgery on Middleton’s UCL, whether an internal brace procedure or Tommy John surgery, would surely end the veteran’s season before it could begin while potentially impacting the 2025 campaign for the righty.

Before signing with the Cardinals on a one-year, $6M deal this past winter, Middleton delivered an impressive 2023 campaign split between the White Sox and the Yankees where he pitched to a 3.38 ERA in 51 appearances. 

He performed especially well in 14 1/3 innings of work down the stretch with the Yankees last year, which saw him post a 1.88 ERA while striking out 30.4 percent of batters faced. 

Last season constituted a breakout campaign for the 30-year-old, as he entered the 2023 campaign with a rather pedestrian ERA of 4.01 for his career across 143 2/3 innings of work with the Angels, Mariners and Diamondbacks.

If Middleton were to go under the knife, it would be a tough blow for a St. Louis club that has also weathered injuries to Nick Robertson and Giovanny Gallegos in its bullpen mix. 

Fortunately for the Cardinals, they’re better situated to weather the loss of a high-upside relief arm than many clubs thanks to the fantastic performance the club has gotten out of closer Ryan Helsley, lefty JoJo Romero and veteran Andrew Kittredge at the back of its bullpen. That trio has combined to post a 2.26 ERA in 75 2/3 innings of work while racking up 75 strikeouts against just 16 walks as a group.

While the news regarding Middleton is certainly ominous, Marmol also provided a more positive injury update on Saturday, as relayed by Denton. 

Left-hander Steven Matz is set to throw what Marmol described as a “full intensity” bullpen session on Monday. If the veteran recovers well after that session, he could head out for a minor league rehab assignment soon. 

That would be a significant relief for the Cardinals, who have been forced to turn to depth options like Matthew Liberatore and Andre Pallante to fill out the club’s rotation while Matz has been out nursing a protruding disc in his back. 

Matz had struggled to a 6.18 ERA in six starts with the club before going on the injured list but could be a valuable piece once healthy, as indicated by his 3.86 ERA (114 ERA+) and 3.75 FIP in 105 innings of work split between the rotation and bullpen last year.