Keynan Middleton To Undergo MRI Following Setback In Rehab

Cardinals right-hander Keynan Middleton is headed for an MRI on his right elbow and forearm this Friday, manager Oli Marmol tells the Cardinals beat (X link via John Denton of MLB.com). There’s now concern that he could require a repair or replacement of the ulnar collateral ligament in his right elbow, Denton adds.

Middleton, 30, signed a one-year, $6MM free agent deal over the winter but has yet to pitch in the majors this season. He began the year on the injured list with a forearm strain suffered in spring training. The right-hander had recently progressed to a minor league rehab assignment, tossing four innings between May 14 and May 23. However, Middleton walked three of the six batters he faced and tossed a wild pitch in his final rehab appearance on May 23. He’s now headed for imaging after reporting renewed discomfort.

Any UCL procedure, be it a repair (likely an internal brace) or a replacement (Tommy John surgery) would sideline Middleton for the remainder of the season and prevent him from throwing a single big league pitch in a Cardinals uniform (barring a reunion on a minor league deal in the offseason). The Cards hold a $6MM club option with a $1MM buyout, but that’s sure to be declined if he winds up requiring elbow surgery. Even if Middleton is able to avoid going under the knife, the latest updates make it fair to expect a lengthy absence.

The Cardinals signed Middleton hoping he could be a key member of the bullpen. The former Angels setup man and closer took several years to get his career back on track following 2018 Tommy John surgery and only reemerged as a viable late-inning arm last season. From 2020-22, Middleton pitched just 60 major league innings and logged a 5.10 ERA with a 19.1% strikeout rate against a 10.7% walk rate. That led to a minor league deal with the White Sox in the 2022-23 offseason — a move that paid off handsomely for both player and team.

Middleton wound up pitching well enough with the Sox to emerge as a trade candidate. He was flipped to the Yankees in exchange for minor league pitcher Juan Carela, a now-22-year-old righty who’s tossed 66 2/3 innings of 3.24 ERA ball in High-A since the swap. Middleton continued to pitch well in pinstripes down the stretch, although he missed about three weeks in September due to shoulder inflammation. Ultimately, he finished out the season with a combined 50 2/3 innings of 3.38 ERA ball between the two clubs, fanning 30.2% of his opponents against a less-encouraging 10.8% walk rate.

For the Cardinals, Middleton is one of several bullpen arms on the shelf. Right-handers Giovanny Gallegos (shoulder impingement), Nick Robertson (elbow inflammation) and Riley O’Brien (flexor strain) are each on the injured list as well — the 60-day IL in the latter’s case. They’ve again leaned on strikeout machine Ryan Helsley in the ninth inning, but the setup corps doesn’t look the way the club expected with both Middleton and Gallegos out.

Offseason trade acquisition Andrew Kittredge has joined lefties JoJo Romero and Matthew Liberatore in picking up meaningful leverage work recently. Liberatore has also started three games but owns an 8.10 ERA out of the rotation compared to a 3.63 mark in the ’pen. It’s possible Rule 5 pickup Ryan Fernandez could work his way into more prominent spots as well. The 25-year-old notched his first MLB hold and his first save within the past two weeks. He’s sitting on a 3.32 ERA, 28.3% strikeout rate, 8.7% walk rate and 44.6% grounder rate. That strong production, coupled with his recent late-inning usage, could be a portent for a bigger role as the season wears on.