Tomlin met with Yocum on Tuesday and, after the doctor examined the right-hander's damaged ulnar collateral ligament, it was determined that Tommy John surgery was the necessary route. Mark Schickendantz -- Cleveland's head team physician -- came to the same conclusion in a meeting with Tomlin on Aug. 13.
Indians head athletic trainer Lonnie Soloff said Tomlin has dealt with right elbow issues off and on over the past few years, but the pitcher never suffered a ruptured ligament. In Tomlin's case, the ligament lengthened gradually over time and eventually began to hinder the pitcher's performance.
If Tomlin becomes a relief pitcher, it is possible that he could return to the club before the end of the 2013 season. Should Cleveland decide to build him up again as a starter, though, Tomlin would likely be part of the 2014 plans.
Cleveland believes the injury explains Tomlin's struggles this season.
"Without a doubt," Acta said. "When guys are having those type of symptoms, the first thing to be affected is the command. Command is such a big part of his game."
This season Tomlin went 5-8 with a 6.36 ERA in 21 appearances, which was a considerable downgrade from his showing (12-7, 4.25) in his first full season in 2011. Tomlin has gone 7-11 with a 6.00 ERA in his most recent 153 innings, dating back to last July. He went 10-4 with a 3.81 ERA in his first 115 2/3 innings last year.
Tomlin's season ended prematurely last August due to soreness in his right elbow.
"In Josh's case," Soloff explained, "dating back to his time in junior college up until last August, he's probably had four or five episodes of ligament sprains. He's done well in each instant over the short-term.
"Even at the present point, it's not disruptive. It's just to the point where it's lengthened enough where it becomes what is termed 'insufficient.' An insufficient ligament begins to just not do its job."