Ramirez, 26, returns to Boston for his second major league stint of the season. The right-hander, who made his first Opening Day roster, had appeared in six of the club's first 12 games before being optioned to Pawtucket following Monday's game against Toronto.
This was not good news for the Red Sox, who already have one starter (Eduardo Rodriguez) on the disabled list. And it was clearly not good news for Kelly, who has battled durability issues the last three seasons.
Kelly recorded just two outs and threw 23 pitches before being forced off the mound in the top of the first inning of a game the Red Sox lost, 3-0, in 10 innings.
"Just a little bit of a pinching type feeling," Kelly said. "Any time I tried to reach back on the fastball, I felt it."
The final pitch Kelly threw to strike out Corey Dickerson was a 94-mph fastball -- the hardest he registered in the inning.
"That was all I got right there," said Kelly. "It was as hard as I could throw the ball at that time. It didn't feel that great, obviously. Hovering around that 89-90 [mph] range was what I had, and I tried to push through it and got the last pitch up to 94 luckily for the strikeout, obviously. It didn't feel very good."
While manager John Farrell did say Kelly will go on the DL, he wasn't ready to disclose who will take Kelly's spot in the rotation. It will likely be Roenis Elias, Henry Owens or Brian Johnson, three lefties who are currently at Triple-A Pawtucket.
Kelly didn't feel 100 percent between starts.
"I felt a little off, but honestly, [I] didn't think much about it. It was typical soreness leading up to the start," said Kelly. "Like I said, I thought I was going to be good to go and went out there and tried to step on the gas and nothing came out.
"In the first inning, warming up, I was like, 'All right, it's a little bit awkward.' Then from pitch one, it wasn't 100 percent. I was trying to push through the whole time, even when the medical staff and John came out. I was trying to push through it and ultimately they made a decision to take me out of the ballgame."
The early exit gave Kelly too much time to think.
"It's really, really frustrating," Kelly said. "After I came out, I sat on my chair and not only upset that the bullpen has been working their tails off and pitching big innings, but it was something going through my head, pondering about what the next step is. I was ultimately frustrated.
"I had a good Spring Training and felt good last year. The first start wasn't what I wanted, but started to feel like I was going in the right direction, and then to have something like this is very disappointing."
Kelly missed the final three weeks of the 2015 season with discomfort in his shoulder.
It was clear from the outset on Tuesday that Kelly wasn't sharp. He walked leadoff batter Logan Forsythe and No. 3 hitter Evan Longoria.
After the strikeout pitch to Dickerson, Farrell and head athletic trainer Brad Pearson visited with Kelly on the mound.
Kelly threw a couple of warmup pitches and then walked off the mound with Pearson.
"The velocity was down from the get-go," said Farrell. "There was maybe more changeups thrown in that first inning than we typically would see. When he's been most effective, we know that there's been a constant mix of pitches. He's gradually worked into his velocity [at times]. I thought that's what was taking place."
Righty reliever Heath Hembree, recalled from Triple-A Pawtucket before the game, replaced Kelly and fired 3 1/3 scoreless innings.