Pitch No. 52 from Carmona, a 93-mph sinker in the second inning, hung over the plate and Curtis Granderson took advantage by belting a two-run home run into the second deck in right field to make it 4-0 Yankees.
So when Carmona's 53rd pitch hung a little too close to Mark Teixeira's head, forcing the Yankees' first baseman to duck and take one on the upper back, Girardi was sure this was not the case of another pitch getting away.
As Teixeira angrily jumped to his feet and yelled toward Carmona -- telling the right-hander he "must've really missed his spot on that one" -- Girardi stormed out of the dugout.
Yankees players responded to their manager's actions, and just like that, the benches and bullpens had cleared, with Girardi and Indians manager Manny Acta appearing ready to take the main event while Teixeira and Carmona settled into the undercard.
"I can't tell you 100 percent, but it's as sure as I can get, because of the way he pitches," Girardi said of Carmona's intent in plunking Teixeira.
No punches were thrown, order was ultimately restored and the Yankees went on to score seven more runs in an 11-7 win, their first in four games.
In their three previous losses to the rival Red Sox, six Yankees were hit. CC Sabathia plunked David Ortiz on Thursday, seemingly ending the matter once and for all, but tempers resurfaced on Friday in the second inning.
"If you want to send a message, if you're upset the way you're pitching and upset you gave up a home run, just throw the ball below the waist," Teixeira said. "I've been hit plenty of times in my career, but any time it's a purpose pitch up near my head, near my neck, I don't like that."
Teixeira has been hit seven times this season, more than any other Yankee. He was hit in the right knee on Tuesday by Jon Lester and knocked out of the game.
Wanting to protect his guy, Girardi was the first of many to step onto the field, hoping that if anyone would be ejected, it would be him.
That was not the case, and neither Girardi nor Acta read much into their exchange afterward.
Acta said the gist of it was, "He did. He didn't. He did. He didn't."
Carmona left after the game without speaking to reporters.
With three games left in this series, Teixeira was not sure if the back-and-forth would continue between two teams with identical records.
"I guess when pitchers are getting hit around they can throw at us," Teixeira said. "That's just the way the game is."
Matt Fortuna is an associate reporter for MLB.com. This story was not subject to the approval of Major League Baseball or its clubs.