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06/10/09 7:30 PM ET

Indians' injury news a mixed bag

Reyes may miss a year, Sizemore tries to avoid surgery

CLEVELAND -- Surgery is on the mind of several members of the Indians' crowded disabled list.

Anthony Reyes is about to have it, Grady Sizemore is trying to avoid it and Jake Westbrook is coming back from it.

Head athletic trainer Lonnie Soloff updated reporters on the condition of all the Tribe's walking wounded Wednesday, and the biggest news was that Reyes will not only receive the season-ending ulnar nerve transposition surgery the Indians recommended for him, but he might also have Tommy John ligament replacement surgery.

There is a distinguishable difference between the two procedures. While both ensure Reyes' 2009 season is over, the transposition would only require four to six months of recovery, while the Tommy John procedure would mean Reyes won't be back in the big leagues for another year.

Reyes visited with Dr. Lewis Yocum in California last week, and the name Tommy John came up for the first time.

"He's had a long-standing ligament insufficiency," Soloff said of Reyes. "He injured it in college, and it hasn't added stability since then. A lot of Major League pitchers have ligaments that don't work well."

With Reyes, it's possible the ligament is the primary cause of the inflammation in the ulnar nerve. Yocum won't know for certain until he operates on Reyes and begins the transposition procedure.

That surgery will take place Friday.

Now, one surgery the Indians hope doesn't take place is the arthroscopic procedure that might be necessary to cure Sizemore's ailing left elbow. Sizemore has stayed away from all baseball activity the past week and will continue to do so for another five to seven days, Soloff said. Sizemore will have an MRI exam on Monday. At that time, the Indians might be ready to make a determination as to whether surgery is necessary.

Soloff said Sizemore's elbow has responded well to treatment, but he's still feeling some soreness on the joint.

"He's made incremental gains in range of motion," Soloff said. "It's hard to say at this point [if surgery will be avoided]. We're happy with the way he's responded the last seven days."

As for Westbrook, he's responded very well to his rehab program after the Tommy John surgery he had last June. He made his first Minor League rehab appearance for Double-A Akron on Saturday, tossing three scoreless innings, and he'll make his second start for Akron on Thursday against New Hampshire. He'll throw four innings or 65 pitches.

Westbrook isn't the only Tribe hurler on the rehab trail. Left-hander Scott Lewis, who strained his left forearm in the April 10 home opener and hasn't been back since, will make his first rehab appearance at Class A Lake County on Thursday, throwing three innings or 50 pitches.

Lewis had a setback in his recovery last month and was transferred to the 60-day DL. His rehab assignment can last up to 30 days, at which point the Indians will have to either add him to the big league roster or option him to the Minors.

The Tribe's other injury updates are as follows:

LHP Aaron Laffey (strained right oblique): Laffey tossed a 30-pitch bullpen session Tuesday, throwing only his fastball and changeup. He'll throw a 40-pitch session Thursday, using all his pitches. The Indians are still hopeful for a late June or early July return for him.

RHP Rafael Betancourt (strained right groin): Betancourt has been going through aquatic therapy and has begun stretching routines. He's still targeted to miss another three to five weeks.

IF Asdrubal Cabrera (sprained left shoulder joint): Cabrera is playing catch and might begin taking grounders this weekend. Soloff said Cabrera might be ready to swing a bat in the next four to seven days. And once he's able to do so, the Indians expect his recovery to be "fairly quick," in Soloff's words.

Anthony Castrovince is a reporter for MLB.com. This story was not subject to the approval of Major League Baseball or its clubs.