According to John Denton of MLB.com, Cardinals right-hander Keynan Middleton will get an MRI this Friday on his right elbow and forearm. Denton continues, “There’s now concern that he might need to have his right elbow’s ulnar collateral ligament repaired or replaced.” Middleton, 30, has not yet made a major league pitch this season despite agreeing to a one-year, $6 million free agent contract over the winter.
Because of a forearm strain from spring training, he was placed on the injured list at the start of the year.
After advancing to a minor league rehab assignment, the right-hander pitched four innings from May 14 to May 23. But in his last rehab outing on May 23, Middleton walked three of the six batters he faced and threw a wild pitch.
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 $6M club option with a $1M 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.
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