Kinney first felt discomfort in his elbow after he pitched in St. Louis' Grapefruit League game against the Astros on Monday. He underwent an MRI exam on Tuesday. After analyzing that exam and other information, Cardinals head team physician Dr. George Paletta recommended ligament replacement.
Paletta will perform the surgery in St. Louis on Tuesday. Kinney is expected to miss the entire season following the procedure, commonly known as Tommy John elbow surgery. He should make a full recovery in time for the 2008 season.
"It's a bump in the road, but it's definitely not a blockade for me," Kinney said. "It stinks. I was really looking forward to being a part of the club this year, helping out and continuing to develop as a player, and I'm just going to have to do that in another way now."
Kinney, 27, emerged as one of the biggest surprises -- not to mention one of the best pitchers -- for St. Louis in its run to the World Series championship last year. He posted a 3.24 ERA in 21 regular-season games, then did not permit a run in seven postseason appearances covering 6 1/3 innings.
The right-hander made two appearances for the Cardinals this spring, allowing three runs each time. After pitching on Monday, he felt his elbow "locking up," experiencing a limited range of motion. The concern led Kinney to check with the Cardinals medical staff.
"It felt like a muscle cramp," Kinney said. "I didn't feel a single thing when I pitched. I sat down [after pitching] and I had my arms crossed, and I watched us and we went three up three down. And I got up to get a drink, and my arm stopped."
Acting on that information, the club called for an MRI on Kinney's elbow. The exam revealed a significant tear in the ligament. Kinney also sustained a severe strain of the flexor tendon in his elbow, but that condition is considered secondary and should heal with rest.
"Based on his exam, based on how the MRI scan looks and based on how he's feeling, we spent a lot of time debating, but it looks like the best option for him is probably going to be to consider reconstructing this," said Paletta.
"I've spoken to a couple other baseball [doctors] to discuss the case with them as well, and the consensus seems to be that [surgery] is the best recommendation, and that's the recommendation I've made for Josh."
Paletta characterized the injury as more gradual than traumatic. The tear of the ligament apparently occurred in steps over time, rather than in one sudden moment.
"This is not a one-pitch, sudden pop of the ligament," he said. "This is more what we call an attritional tear, where the ligament likely failed gradually over time, over the course of the last 18 months, and finally reached the point where he can't compensate for it."
The injury to Kinney furthers the questions in the Cardinals bullpen. Two key relievers from 2006, Braden Looper and Adam Wainwright, have been moved to starting jobs, which had left Kinney projected as the primary late-inning right-handed setup man. Jason Isringhausen is progressing well in his rehabilitation from last year's hip surgery, but he has yet to pitch in a game this spring.
Although St. Louis has considerable depth in its relief corps, the loss of Kinney removes the only consistent right-handed strikeout threat other than Isringhausen. The question of who will set up the closer is now wide open.
Matthew Leach is a reporter for MLB.com. This story was not subject to the approval of Major League Baseball or its clubs.