Alek Manoah Headed For Second Opinion, Likely Facing Lengthy Absence

May 31: Manoah is headed for a second opinion on his elbow, reports TSN’s Scott Mitchell. His initial diagnosis isn’t yet known, but Mitchell adds that it’s expected Manoah will be sidelined for an “extended period of time.”

May 29: Alek Manoah left tonight’s start against the White Sox in the second inning. The team announced he experienced elbow discomfort. Manager John Schneider told the Toronto beat after the game that Manoah will get an MRI tomorrow (X link via MLB.com’s Keegan Matheson).

Manoah lost the first month of the season after battling shoulder discomfort during the spring. He was reinstated on May 5 and has taken the ball five times. The burly right-hander was out to an encouraging start to the season, working to a 3.70 ERA with 26 strikeouts and eight walks across 24 1/3 innings. Manoah wasn’t back to his Cy Young finalist form of 2022, but it was a substantial improvement over last year’s disappointing season.

There’s little to be done now beyond hoping that imaging doesn’t reveal any structural concerns. Manoah’s fastball sat in the typical 92-93 MPH range during the first inning. He didn’t top 90 MPH in the second inning until throwing Dominic Fletcher a 91.4 MPH sinker to start his at-bat. Manoah seemed to wince after releasing that pitch and departed the game following a mound visit (video provided on X by Sportsnet’s Shi Davidi). Trevor Richards came in for 3 1/3 scoreless innings of emergency relief to help Toronto to a 3-1 victory.

The Jays are working with limited rotation depth behind their front five of Kevin Gausman, Yusei Kikuchi, José Berríos, Chris Bassitt and Manoah. Offseason signee Yariel Rodríguez has been on the injured list since April 30 with back inflammation. Bowden Francis, who opened the season in the rotation when Manoah was on the shelf, has been out for the last month with forearm tendinitis.

Rodríguez and Francis are each on rehab stints with Triple-A Buffalo. While both pitchers should be back before long, they’ve each got questions about their viability as starters. Rodríguez barely pitched in 2023 as he went through the process of applying for free agency. He pitched out of the bullpen in Japan two seasons ago. Francis was rocked in his first two MLB starts this year and quickly kicked to multi-inning relief, where he had more success last season.

Paolo Espino, who has a 4.81 ERA over eight starts with Buffalo, is the only other traditional starter on the 40-man roster. Toronto brought back old friend Aaron Sanchez on a minor league deal earlier this month, but he has given up 17 runs in 10 2/3 Triple-A innings. Beau Sulser, another recent non-roster acquisition, has surrendered 12 runs in 14 1/3 Triple-A innings in a swing role. Top prospect Ricky Tiedemann is back on the minor league IL because of a nerve issue in his elbow.

If Manoah needs to go on the injured list, Espino seems the logical choice to hold the fort until Rodríguez is ready to return. Toronto’s rotation would look perilously thin in the event of any other injuries. While the Jays benefitted from remarkable rotation health last season,  they relied on Richards to kick off a few bullpen games last summer while Manoah was in the minors. Perhaps they’d look at that as another short-term solution, but starting pitching would likely be a deadline priority if the Jays are in the postseason picture in July.