MRI on Karns' elbow comes back clean

Orioles reliever Nate Karns is confident that he's going to avoid surgery on his right elbow.

Karns received a second opinion yesterday from Dr. James Andrews in Pensacola, Fla., and an MRI showed no evidence of structural damage. He received an injection to alleviate the tightness in his forearm and will remain shut down.

"Doing great, doing great," Karns said this afternoon while standing at his locker. "Second opinion went well. My MRI is clean. We just got a shot to kind of help with the discomfort, so with the MRI being clean, that's the best results right there. Not as quickly through the process, but we're getting through it.

"Something was just irritating my forearm in a sense. We need to free up some space, just more soft tissue, and we got an injection to kind of help that along. But structurally we're good, UCL (ulnar collateral ligament) is good. There's nothing in there that indicated anything that needed any surgery or any red flags. Just kind of a slow progression, I guess."

Karns was placed on the injured list retroactive to April 9 after making four appearances with the Orioles, who signed him to a one-year, $800,000 deal on Feb. 7. He said the injury shouldn't be classified as a forearm strain, the condition that led to him missing the entire 2018 season.

"Last year was a forearm strain. That's pretty much the difference right there," he said.

"This is just kind of bad luck I guess, really. MRI was good at the beginning of the season. It improved between then and now, so just an unfortunate, slow-moving process right now."

Calling his current injury a forearm strain is a "bad choice of words," Karns added.

"It's not a forearm strain. This is just kind of like right forearm tightness, and we went in there to check it out and something is just causing forearm tightness.

"When you have a clean MRI it's kind of hard to indicate anything. Just one of the things that's slow-moving."

But how slow? Karns said he'll remain shut down for about a week before going on a throwing progression.

Manager Brandon Hyde also was encouraged by the diagnosis, which the club received last night.

"He's going to resume throwing in a week to 10 days-ish," Hyde said.

"I was just told that it came out good. Medically, I know there's a lot of big words I don't know. All I know is it was good news and he'll start throwing when everything kind of dies down, a week to two weeks."

Karns hasn't pitched since retiring all three batters in the ninth inning of an April 8 game against the Athletics. He made one rehab appearance at Triple-A Norfolk and one at Double-A Bowie before returning to Baltimore and undergoing another examination on his elbow and forearm.

"I was 90-93 my last rehab start," said Karns, who allowed one unearned run and seven hits with three walks in 5 1/3 innings with the Orioles. "It was still with some discomfort, so the whole reason I got put on the DL was because of the discomfort. We were just kind of figuring out with all the rehab we should not be having that, so it was one of those things where I pitched, was 90-93, came back the next day and I was tender. We were just like, that's not going to be really productive to come off the DL kind of laboring through it.

"When you come off the DL you want to be ready to go, you don't want to be a liability in the bullpen. That's just kind of what happened. Took a step forward, we tried to take a step back. Now we're going to build back up and get after it in a couple days. But I did get an injection in the forearm, so with all that being said, doctors feel good about it, I feel good about it, so time will tell."

Visits to Dr. Andrews frequently produce bad news, so Karns felt relieved that his season hadn't ended again. He's appeared in only 13 games since 2016.

"It was definitely awesome to have that," he said. "It's encouraging, really. You come into the season with a clean MRI and ... you go get another one, you're always concerned, but when it came back clear, it's positive. But at the same time, still a little frustrating that we're having the slow-moving progress.

"Once we have the shot, everybody feels like that's going to be able to put us over the hump and get back to pitching."