Tommy John surgery has now been recommended.
Ohtani has been dealing with a small UCL tear over the last few years, missing some time in the Japanese league last season and in MLB this year.
The Angels shut the 23-year-old down in June with hopes of letting the injury heal on its own and then decided to pitch him again on Sunday against the Houston Astros after three months away from the mound.
He tossed 2.1 innings allowing two earned runs on 49 pitches before he was taken out. His velocity dipped from 99 mph in the first inning to 91-94 in the third.
If Ohtani is done for the season the Angels will lose both a good starter and a middle-of-the-order bat.
Ohtani has a 4-2 record with a 3.31 ERA on the mound and is batting .276 with 16 home runs and 44 RBIs.
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