BOSTON -- The sight was ominous Friday night.
Daisuke Matsuzaka standing on the mound at Fenway Park, head down, with none out in the fifth inning, surrounded by manager Terry Francona, assistant trainers Greg Barajas and Masai Takahashi and the entire Red Sox infield.
They talked about Dice-K's right elbow, which had tightened up on the right-hander. They talked about whether he should come out of the game.
And then, after a few minutes of question-and-answer translations, there was Matsuzaka, walking off the field with Francona and the trainers, done for the night because of that tightness.
Now the question is whether Matsuzaka is going to be gone from the starting rotation for a while, dispatched to the disabled list. Elbow woes tend not to heal quickly.
Not so fast, though, said the Red Sox and Dice-K, adopting a glass-is-half-full mantra after the game, which ultimately turned into a tough 5-4 loss to the Seattle Mariners.
Bobby Jenks blew a save, scorched for two runs on three hits in the seventh as a 4-3 Boston advantage became a 5-4 deficit. And the Red Sox were unable to come back as Mariner pitchers Jason Vargas, Jamey Wright and Brandon league combined to retire the final 13 Boston hitters.
Mike Cameron clubbed his first two homers of the year and the Sox also got a run-scoring single from Kevin Youkilis and David Ortiz.
But the story of the night, and likely for the next several days, if not longer, is Matsuzaka's elbow. His next scheduled start would be Wednesday night against the Angels. Francona isn't ruling it out.
"I think we think he'll be OK for his next start," said Francona. "We'll check him out."
"I have an idea what's going on with my elbow right now so I'm not too worried about it," said Matsuzaka through a translator. "That kind of tightness happens sometimes. I don't really pay attention to it."
There was enough concern, however, to lift Matsuzaka from the game even though Dice-K said he thought he could have continued to pitch.
Francona yanked him after Matsuzaka had served up a line-drive single to center on a 3-and-1 pitch to Ichiro Suzuki leading off the fifth with Boston on top, 4-2.
"We watched him between innings and it looked like he was stretching out his arm," said Francona. "We watched him out there. His velocity dropped significantly. We went out and he said it was stiff. He didn't put up a fight. We have to be cautious. It was hard to leave him in there."
Matsuzaka respectfully disagreed, but obediently left the mound.
"I could have continued to throw," said Matsuzaka. "I didn't feel I needed to come off the mound. I left the judgment to Tito. That was his decision to come off the mound. I understand Tito is always concerned about all his players. I feel sorry to make him concerned about my elbow."
If the concern is great enough and Matsuzaka has to be shut down for one start, the Sox could pull veteran knuckleballer Tim Wakefield out of the bullpen to take that spot in the rotation. If Matsuzaka is going to be out longer than one start, Wakefield could inherit the role, though Boston does have Felix Doubront and Andrew Miller in Pawtucket, as well as swing-man Alfredo Aceves with the Pawtucket Red Sox.
While Matsuzaka said he didn't feel a problem with his elbow until later in the game, he certainly did not look like the same pitcher who had been so outstanding in his previous two starts. Dice-K had allowed one hit in each of those games, working a total of 15 scoreless innings in the two outings.
Friday night, Matsuzaka didn't appear nearly as comfortable on the mound. His rhythm was inconsistent, leading to the appearance of the Dice-K who has been so frustrating to watch for the Sox and their fans since he arrived in 2007. He had a lot of long counts, going to three balls on seven batters, walking four of them.
By the end of the fourth inning he had thrown 77 pitches, though the Mariners scored against him only in the first inning, taking a 2-0 lead on a walk, two singles and an error by left fielder Darnell McDonald.
"There were times when he was laboring tonight," said catcher Jason Varitek of the pitcher. "But nothing drastic. He even settled in a bit."
Varitek, though, could see when Matsuzaka began to struggle.
"There was a difference in the rotation on the ball. There were some mechanical differences. Things weren't clean," said Varitek.
So Saturday, Matsuzaka will get examined further by the Sox medical staff, hoping to get a clean bill of health.
"It's not my decision for my next game," said Matsuzaka, addressing whether he thought he would have to miss a start, "but I will see how I feel after tonight and get checked out again tomorrow."
Steve Krasner is a contributor to ESPNBoston.com.