Medlen underwent an MRI exam on Monday that showed damage around the ulnar collateral ligament of his right elbow. A stress X-ray conducted on Tuesday provided a stronger indication that the ligament damage will need to be surgically repaired.
A definitive decision will likely be made within the next two days. The process has been slowed due to the fact that Dr. James Andrews, who performed Medlen's Tommy John surgery in 2010, is among the contingent of orthopedic surgeons currently attending a conference in New Orleans.
"That stress X-ray is not definitive, but it did probably confirm what he was fearing -- that there is a high likelihood he will have to have another Tommy John," Braves general manager Frank Wren said.
Medlen said it felt like a knife was going through his elbow when he threw a curveball to Mets outfielder Curtis Granderson during the fourth inning of Sunday's game. The sensation was quite similar to what he felt on the last pitch he threw before undergoing surgery in 2010. Still, the righty threw two more pitches to Matt Clark before walking directly toward the dugout and prior to talking to manager Fredi Gonzalez or a member of the club's medical staff.
"I threw [a first-pitch fastball to Clark], and it was like an eight, nine or 10 on the pain scale feeling," Medlen said. "In 2010 when I did it, I think the pain was an eight. I felt like the damage had been done, but I was kind of denying it to myself. I wanted to get through it and talk myself out of that feeling. It was more of a denial, frustration, anger thing."
As Medlen endured what proved to be 13 months of rehab before he returned from the elbow surgery two years ago, he told himself he would never put himself through that again. But now that he is staring at the prospect of doing so, he is willing to accept the even greater challenge that comes with returning from a second Tommy John procedure.
"It's kind of like, 'OK, let's get this taken care of,'" Medlen said. "It's not like a woe-is-me or why me? I don't think like that. I wouldn't be at this level being [a smaller guy] or whatever. I wouldn't be at this level thinking that way. I feel like I carry the flag for the underdogs and the people who believe in themselves when no one else does. I've had a good support system coming up, and those are the people I play for. I just want to do it for them."
Mark Bowman is a reporter for MLB.com. This story was not subject to the approval of Major League Baseball or its clubs.