"The fact is there are not a lot of guys that have had that surgery and come back successfully," Rangers general manager Jon Daniels said. "I feel for Matt and his family. It is a blow to the club, but he has worked extremely hard to come back. Although the odds aren't great, we hope he's the exception."
Perez has a partial tear of the ulnar collateral ligament in his left elbow and is looking at the possibility of undergoing Tommy John elbow reconstruction surgery, a procedure that would sideline him for at least a year.
Perez's other option, since it is only a partial tear, is to try to rehab the elbow without surgery. But he would still be out 10-12 weeks and there's no guarantee he wouldn't ultimately need the procedure anyway.
"I've talked to Martin's agent, and we're going to sit down and talk with him on Friday," Daniels said. "We're still going through it and doing our homework. No decision has been made yet."
Nick Tepesch was called up on Wednesday to replace Perez in the rotation. The Rangers are also going to bring Nick Martinez back out of the bullpen to take Harrison's spot. The Rangers have not announced any starters beyond Yu Darvish pitching Friday against the Blue Jays. Robbie Ross Jr. will likely pitch Saturday and Colby Lewis on Sunday.
The Rangers now have a full rotation on the disabled list in Perez, Harrison, Derek Holland, Tanner Scheppers and Joe Saunders, not to mention the many other injuries that have clobbered them since Spring Training.
"The sheer number of injuries is startling," Daniels said. "We have had a combination of everything. We're hardly the only club going through this. It is what it is. Nobody is going to cry for us. We've got some guys that need to step up, but the sheer number of injuries is a challenge."
The Rangers, who called up reliever Miles Mikolas to replace Harrison on the roster, went into Wednesday's game with the Astros in fourth place in the American League West with a record of 20-20. They were 4 1/2 games out of first.
"We'll see how we weather the storm," Daniels said. "It doesn't change our expectations until we see how the team handles it. Teams handle injuries all the time. We'll see how it plays out. I'm not selling our club short. It's an opportunity for other guys to step up. I'm not selling our club short."
The Rangers will look for starting pitching help elsewhere but it's unlikely they can do anything this early in the season. "We're going to let it ride out," Daniels said. "We may consider that but not a lot of clubs have pitching,"
Saunders, sidelined with a stress fracture in his left ankle, is scheduled to make his third start on medical rehab assignment for Triple-A Round Rock on Thursday. But he is still working on some mechanical issues and Daniels said he could need a couple of more starts before he is an option.
Holland, who had surgery on his left knee in January, is still in Arizona on a throwing program. He is throwing live batting practice but has not progressed with his fielding to the point where he can go on a rehab assignment. He is scheduled to return to Arlington to be re-evaluated before the Rangers decide on the next step. Scheppers, who has inflammation in his right elbow, has just begun throwing off a mound.
Harrison was an 18-game winner for the Rangers in 2012 but made just two starts last year before going down with a herniated disc in his lower back. He twice underwent surgery to repair the problem and came to Spring Training ready to compete for a spot in the rotation. He was set back 2-3 weeks by early back stiffness and started the season on the disabled list.
He was finally activated on April 27 and made four starts. But he had to come out of Tuesday's game against the Astros in the second inning because the back was bothering him and he was sent back to Dallas on Wednesday to be examined by Dr. Drew Dossett. The news was not good.
"It's a more significant injury and the odds of a full return are lesser than the other traditional operations that we are accustomed to," Daniels said.
Perez was 4-0 with a 1.42 ERA in his first five starts but 0-3 with a 12.83 ERA in his last three outings. He complained of elbow soreness after his last start against the Red Sox on Saturday and was examined by Dr. Keith Meister. The diagnosis of a partial tear was confirmed in a second opinion by Dr. James Andrews.
The question now is if Perez will undergo Tommy John surgery or attempt to rehab the elbow in the hope that he can pitch later this summer. But it will be August before he returns at the earliest.