What's next for Cardinals ace Adam Wainwright and his sore arm?

Injuries are the worst part of baseball. It's particular bad when a pitcher suffers an injury to his throwing arm. Unfortunately, on this Thursday morning, injured is the current state of St. Louis Cardinals ace starter Adam Wainwright.

Here's what we know about Wainwright's current physical condition:

• Per the St. Louis Post-Dispatch game story for Tuesday night's contest by Derrick Goold, Wainwright struggled to control his pitches last night, especially his breaking ball. In the article, Goold mentioned the adversity Wainwright has fought through so far this young season—including tendinitis.
• MLB.com's Jenifer Langosch writes that Matheny stated Wainwright has pitched through similar health issues previously.
• Langosch tweeted that Wainwright left the team in Tampa and flew back to St. Louis for an MRI on his throwing arm on Wednesday.
• Both Goold and Langosch reported that the MRI revealed no structural damage to Wainwright's throwing arm.
• General manager John Mozeliak specifically said that the MRI revealed no ligament damage. This is important because Tommy John surgery (which Wainwright underwent in 2011) is a procedure in which a player's ulnar collateral ligament (UCL) is replaced.
• Mozeliak said that Wainwright's injury is "similar to tennis elbow." As we discussed yesterday, tennis elbow is a condition that impacts tendons, not ligaments (like the UCL). Per a Langosch tweet, Matheny indicated Wainwright is dealing with tendinitis. This is an important distinction because ligaments connect bone to bone while tendons connect muscle to bone.
• Goold reports that Wainwright received an anti-inflammatory injection in his throwing arm. The injection was presumably cortisone—a drug that Joe wrote an excellent profile about earlier this year that I highly recommend reading.

The Cardinals will take a wait-and-see approach with their staff ace. Goold relays that the team plans to be cautious with Wainwright because the thought of finishing the season without him is horrifying (I'm paraphrasing Mospeak here). Langosch passes along that, on the other hand, Matheny is not yet ready to count Wainwright out for his next start. Brian Stull of STL Baseball Weekly reports that the Cardinals will wait until Friday to make a decision as to whether Wainwright will make his scheduled start on Monday. If Wainwright's arm requires it, the club will give the righty a start or two off.

Also from Stull's post, this window into Mozeliak's mindset:

"I’m not overly concerned, but anytime you have a player that requires an MRI and an injection it’s certainly reason to have to take pause."

Keep calm and take pause.

For what it's worth, it appears that the current worst case scenario is that Wainwright will miss a start or two to rest his tendinitis-inflicted throwing arm. Such a necessity would strike at a bad time for the Redbirds. Their starting pitching—which seemed so deep in the spring—has been thinned by injury.

• Joe Kelly, still sidelined by a torn hamstring, just started throwing again from a mound. He hasn't yet embarked on a rehab stint and likely won't be MLB game ready for weeks.
• Lefty Tyler Lyons, who hit the DL with a shoulder injury, kicked off his rehab stint with Springfield on Tuesday with two innings of work. But the southpaw also won't be ready to start an MLB game come Monday should the Cards need a Waino replacement.
• Carlos Martinez is not an option. Given the Cardinals' handling of the rotation hole left by the disabled Kelly, the organization does not appear inclined to install Martinez in the rotation this season. And even if the Cardinals were, Martinez is not stretched out enough to take the ball on Monday and throw anything more than two or three innings.
• The Memphis rotation doesn't currently have a starter who is knocking on the majors' door. Tim Cooney's strikeout rate—which was so surprisingly good a year ago—has shrunk back down to pre-Springfield levels and his FIP has ballooned correspondingly. Boone Whiting has pitched about as well as Angel Castro by DIPS stats but has allowed far more runs than the chunky Western Oklahoma State College alumnus. At the moment, there just isn't a Triple-A pitcher that seems like a good MLB fill-in.
• In Double-A, there isn't a pitcher making a strong case for a major-league promotion, either. I suppose one could argue that the club could call on Marco Gonzales, but the lefty has made just five starts for Springfield. Those starts are his only experience above A-ball.

The Cardinals find themselves in an unenviable quandary. The club wants to exercise caution with their staff ace to ensure his health over the long haul—not just 2014, but the four years after that as well. (St. Louis owes Wainwright $97.5 million from 2014 through 2018.) But injuries have left them without a clear choice to promote as an emergency starter in Wainwright's stead. For now, we wait. Perhaps a replacement won't be needed.