Nova, who was diagnosed with a partial tear of the ulnar collateral ligament after leaving a game against the Tampa Bay Rays in the fifth inning on Saturday, underwent a second MRI on Tuesday in New York which confirmed the original diagnosis. According to team press release, Yankees team doctor Christopher Ahmad recommended Nova undergo surgery.
"It's unfortunate," manager Joe Girardi said. "Obviously he has to make a decision now."
Nova is not with the team in Boston, where the Yankees are opening a three-game series against the Red Sox Tuesday night and could not be reached for comment.
But other pitchers have sought to delay or avoid Tommy John surgery, which entails a 12-18 month recovery period. Most recently, New York Mets right-hander Matt Harvey waited nearly two months after tearing his UCL before undergoing surgery, and toyed with the idea of trying to rehab the injury without an operation before finally going ahead with the procedure last October.
Girardi said he had not spoken to Nova since the results of the second test became known Tuesday afternoon.
"I don't know if he'll go for another opinion or what he'll do; that's a player's option," Girardi said. "I'm sure it's the last thing that he wanted to hear. Sometimes it takes a little time to sink in before you can make a decision, but that's what our doctor recommended. We'll wait to hear what his decision is."
Nova left Saturday game after feeling pain in his right elbow after delivering a curveball to the Rays' Evan Longoria, the third batter he faced in the fifth inning. Yankees bench coach Tony Pena noticed Nova shaking out his pitching arm, and catcher Brian McCann said he saw the 27-year-old wince as he let the ball go.
Nova was being hit hard before the injury -- he was trailing, 6-0, when he left the game and wound up being charged with eight earned runs in four-plus innings -- but said afterwards it had nothing to do with his ineffectiveness.
"It was just that one pitch," he said. "Honestly, I didn't think that I was hurt. It was just kind of a little pop, like when you feel a friction or something.
"Sometimes you feel something, you don't think right away, I hurt myself. When you're out there in the game, you just want to pitch."
In contrast to previous years, Nova came to camp this season with the No. 4 starter's job already won based on his performance in 2013, when he went 9-6 with a 3.10 ERA. The Yankees were especially excited about Nova this season because he finished up last year 5-2 with a 2.82 ERA over his last 11 starts.
"We had high hopes for him because of what he did at the end of last year," Girardi said. "His spring training was very, very good. We had big expectations for him. Whenever you lose a starter, it's a blow. It's a big blow, just because it's guys that you're counting on to go out and compete every fifth day, give you 200-plus innings and be a big part."
In Nova's absence, Michael Pineda, who won the No. 5 starter's job in spring training, moves up to the No. 4 slot and Vidal Nuno, who pitched five scoreless innings as an emergency starter in the Yankees 5-1, 12-inning victory over the Rays on Sunday, becomes the No. 5 starter.
"It's time for someone else to step up," Girardi said. "That's the reality of baseball. Every team has to deal with injuries and no one's going to feel sorry for you."
Many pitchers have been diagnosed with torn elbow ligaments, requiring Tommy John surgery, since the start of spring training, including Rays left-hander Matt Moore; Braves right-handers Kris Medlen, Brandon Beachy and Cory Gearrin; Diamondbacks ace Patrick Corbin; Athletics starter Jarrod Parker; Mets closer Bobby Parnell; Royals setup man Luke Hochevar; Tigers reliever Bruce Rondon; and Pirates top prospect Jameson Taillon.