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06/30/09 6:50 PM ET

Surgery likely for Sizemore after season

Troublesome left elbow continues to be irritated

CLEVELAND -- Grady Sizemore is playing through pain, and the Indians' All-Star center fielder appears likely to have arthroscopic surgery on his left elbow at season's end, according to head athletic trainer Lonnie Soloff.

Soloff said Tuesday that there is a "high index of suspicion" Sizemore will have the surgery when the '09 season concludes. The Indians are letting him play through the pain now, because it is tolerable enough not to have an overbearing effect on Sizemore's performance.

Sizemore was on the disabled list from May 31-June 23 because of inflammation in the elbow. The Indians have said that MRI examinations on the elbow have not revealed structural damage.

The arthroscopic surgery would clean out Sizemore's elbow joint and rid it of the inflamed mass. It would require about a four-to-six-week recovery period.

It remains possible that Sizemore would have the surgery in-season if the elbow flares up on him again. For now, the Indians are keeping it under control with treatment and occasional rest.

Until he has the surgery, Sizemore, who is batting .226 with 10 homers and 39 RBIs on the season and .250 (6-for-24) with a homer and eight RBIs in six games since his return, will just have to grin and bear the pain.

"He'll have symptoms for the balance of the season," Soloff said. "Our hope is that we can keep him away from symptoms that affect his performance or put him at a risk for injury."

Soloff updated reporters on some of the other injured Indians:

LHP Scott Lewis (left elbow strain): Lewis, who suffered his injury in the Indians' home opener, pulled himself out of a rehab start at Double-A Akron on June 21 after four innings of work. He has been examined by team physician Dr. Mark Schickendantz and will be examined again by Dr. James Andrews in Birmingham, Ala., next week.

The Indians are not recommending surgery for Lewis.

"We hope [Andrews] can lend his expertise on how to get Scott over the hump," Soloff said. "He's effective when he pitches. In his last start, he pitched four innings and gave up just one hit. But he's not to the point where he subjectively feels 100 percent."

Andrews performed Tommy John elbow ligament replacement surgery on Lewis at the end of Lewis' sophomore year at Ohio State in 2003. Soloff said this injury is indirectly, not directly, related to that past surgical procedure.

RHP Jake Westbrook (2008 Tommy John surgery): Westbrook had a setback in his recovery and was shut down from throwing for two weeks. That period of inactivity has come to a close, and Westbrook will begin a return-to-throw program Thursday.

Soloff said Westbrook, who made two rehab starts at Double-A Akron before the setback, will spend at least a week throwing off flat ground before progressing back to the mound.

"If things progress as we hope," Soloff said, "he could be an option for us [at the big league level] in late July or early August."

RHP Rafael Betancourt (right groin strain): Betancourt will throw a two-inning or 35-pitch simulated session Thursday at Progressive Field. It will be his fifth time throwing off a mound in his rehab. If all goes well, Betancourt might be deemed ready for a rehab assignment with Triple-A Columbus on Friday.

LHP Aaron Laffey (right oblique strain): As previously reported, Laffey will make his fourth rehab start Friday for Triple-A Columbus in Toledo. He will throw five-to-six innings or 80-95 pitches.

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