Williamson to undergo Tommy John; '25 return in question

CINCINNATI – Following an arduous journey to get all the way back this year from a shoulder injury, Reds left-handed starting pitcher Brandon Williamson now faces a new one – elbow surgery.

Williamson's MRI exam before Wednesday's 7-1 loss to the Braves revealed that he had a complete tear of the ulnar collateral ligament in his left elbow and he will need Tommy John surgery that could likely cost him most or all of the 2025 season. The Reds were officially eliminated from postseason contention after the loss in the second game of the series against Atlanta at Great American Ball Park.

“I know what next year looks like. I just went through most of it this year," Williamson said. "It’s my challenge now. It’s my career. I’m going to make the best of it. Pouting or being upset about it doesn’t help at all. I’ll just keep laying bricks.”

A surgery date and timeline has not been set.

During the Reds' 6-5 win over the Braves on Tuesday, Williamson lasted only 1 1/3 innings and 48 pitches before he grabbed his left elbow and exited the game.

“It kind of came out of nowhere," Williamson said. "I hadn’t really been feeling anything in my elbow for, dare I say, my career. I’ve always been more of a shoulder guy. I felt like I cleaned my shoulder up and came back, and for whatever reason, my elbow went.”

In a 34-pitch first inning, Williamson gave up three hits that included a pair of home runs to get into a 3-0 hole.

Williamson felt nothing was wrong physically during that rally.

“That was just baseball in the first inning," he said. "What I would say is I felt a little off, non-physically-wise. … In the second inning, after a long first inning, I felt like I was having to put a little extra into it to try and get warm, get going."

Williamson needed 10 pitches before he retired leadoff batter Orlando Arcia with a popout to the shortstop in the top of the second inning.

"No red flags for me. I felt fine," Williamson said.

On his third pitch to next batter Michael Harris II, something changed.

“I felt a little tweak there," Williamson said. "I tell everybody that if you’re a pitcher you feel stuff all the time. I didn’t think too much of it."

On a 2-2 fastball fouled off by Harris, Williamson grabbed his arm.

"The next pitch, it just went. I just felt it," he said. "I never had any elbow issues so when it happened, I knew something felt wrong but I didn’t know what.”

An initial MRI taken immediately after his outing on Tuesday night revealed elbow damage. A second MRI with contrast dye was ordered for Wednesday – which revealed the tear.

“It’s obviously unfortunate and we feel for Brandon to have to go through this, especially because of what he’s been through already," Reds manager David Bell said. "Now, we just move forward. He’s still young, he’s talented, he’s athletic. He’s going to come back better. It’s happening for a reason and he’s going to use it to heal up, get stronger and be back stronger and better than ever.”

Williamson, 26, was among four players acquired by Cincinnati from the Mariners in the March 2022 trade for Jesse Winker and Eugenio Suárez. He endured shoulder issues in the Minors during that season but was healthy in 2023, going 5-5 with a 4.46 ERA in 23 big league starts as a rookie.

During Spring Training, Williamson came down with a left shoulder strain and opened 2024 on the injured list. During his first rehab assignment, a setback shut him down when a lesion had developed on a shoulder ligament. He was able to avoid surgery by undergoing injections and more rehab.

Williamson had a second rehab assignment of one start, but he was called back to help a depleted big league rotation. In four games (three starts) since his return on Sept. 1, he posted a 3.77 ERA. It was a 2.08 ERA entering Tuesday.

There were changes made over the summer to help Williamson's shoulder stay strong while pitching. He was asked if those changes essentially came at the expense of his elbow.

"Working with the training staff in Arizona all summer, I felt like I started throwing cleaner," he said. "I figured out how to throw without any sort of pain or fatiguing that had been weighing on it before. To say that’s why my elbow went is, to me, just speculative. I can’t say that for certain.”