KANSAS CITY, Mo. -- Felipe Paulino tore a ligament in his right elbow and likely will become the fourth Royals pitcher to have Tommy John surgery this season, tempering the positive news that catcher Salvador Perez is finally coming off the disabled list.
The Royals announced in a statement Friday that team doctors diagnosed Paulino with a torn ulnar collateral ligament, which usually requires season-ending reconstructive surgery. The right-hander will get a second opinion from Los Angeles Angels medical director Dr. Lewis Yocum.
Kansas City already has lost starter Danny Duffy, reliever Blake Wood and closer Joakim Soria to Tommy John surgery. Yocum performed the procedure on all of them.
Perez is expected to start Friday night's series opener against the St. Louis Cardinals. He's been out since the middle of spring training, when he tore the meniscus in his left knee.
Paulino had revitalized his flagging career in Kansas City, which acquired him from Colorado for cash last May. He opened the year on the disabled list because of a strained left forearm, but was 3-1 with a 1.67 ERA in seven starts.
He did not allow a run in four of those outings.
Paulino was coming off six innings of three-hit ball against Oakland when he hurt his groin in the first inning June 6 against Minnesota. He landed on the DL a few days later, and was on a rehab assignment at Double-A Northwest Arkansas when the elbow injury was discovered.
He was pulled after throwing 54 pitches in three innings Wednesday night.
The Royals have spent all season patching together a starting rotation, especially after they lost Duffy, who had reconstructive elbow surgery after leaving a start May 13 in Chicago.
Jonathan Sanchez spent time earlier this season on the disabled list, and fill-in starter Everett Teaford also has been hurt. All told, Kansas City has used 10 starting pitchers this year.
It's unclear who will move into the rotation in Paulino's place, though Will Smith and Nate Adcock have made starts for Kansas City this season. Jake Odorizzi might finally get a chance at the big leagues after going 4-0 with a 2.41 ERA at Omaha, while fellow Triple-A prospects Mike Montgomery (3-3, 4.79) and Ryan Verdugo (5-2, 3.65) also could get a look.
The 22-year-old Perez made a big impression on the Royals late last season, hitting .331 with three homers and 21 RBIs in 39 games. It was enough for Kansas City to sign him to a $7 million, five-year deal that includes three team option years during spring training.
Perez tore cartilage in his knee on March 13, shortly after signing the new contract. The Royals purposely took it slow with his rehab, making sure Perez could catch a full nine innings before he returned to the big league club, and he hit .340 during 12 games at Omaha.
Kansas City acquired Humberto Quintero after Perez got hurt, and he's split time behind the plate with Brayan Pena. Royals manager Ned Yost said he's willing to carry three catchers for now, but that could change depending on roster needs going forward.