LAKE BUENA VISTA, Fla. – An MRI on Kris Medlen's injured elbow showed "some involvement in the ligament," Braves general manager Frank Wren said, and the pitcher will have further tests and a second evaluation before determining whether he needs surgery.

Medlen left Sunday’s game against the Mets after grabbing his right arm and hopping off the mound in obvious pain after a fourth-inning pitch.

The right-hander had Tommy John ligament-transplant surgery in 2010 and missed most of the 2011 season. If he needs another Tommy John surgery, he would join Braves reliever Jonny Venters in trying to become one of the few pitchers to compete a high level again after having the surgery twice.

Medlen is expected to consult with Dr. James Andrews, who did his Tommy John surgery. MRIs on patients who previously had Tommy John surgery can be difficult to read, and the previous surgeon is consulted before any additional steps are taken after another injury.

Medlen left Champion Stadium without speaking with reporters Wednesday because he had to get to appointment in Orlando for further testing, a Braves spokesperson said. He met with Braves doctors Wednesday morning and went over the findings of the MRI and exam.

The Braves’ list of health issues with their starting pitchers continues to grow, and Wren said they are exploring options to add to the staff. The Braves have inquired about unsigned free agent Ervin Santana, who had a 3.24 ERA and 161 strikeouts in 211 innings last season for the Royals.

Medlen has been the Braves’ best starting pitcher since moving from the bullpen in late July 2012. He is 24-12 with a 2.47 ERA in 44 games (43 starts) since then, and his 2.40 ERA since the 2012 All-Star break is the second-best in baseball among pitchers with at least 250 innings, behind Dodgers ace Clayton Kershaw.