The left-hander will undergo an MRI on his left elbow and make another visit to see renowned orthopedic surgeon Dr. James Andrews.

The Red Sox received more discouraging news regarding Chris Sale.

The left-hander will undergo an MRI on his left elbow and make another visit to see renowned orthopedic surgeon Dr. James Andrews. What promised to be a start to 2020 on the injured list due to an illness could soon become something much worse.

Sale reported soreness to Boston medical staff just two days after throwing 15 pitches in a live batting practice session on Sunday. It was his first time facing hitters since his final start of 2019, a 7-6 win over the Indians at Progressive Field on Aug. 13. Sale was shut down due to left elbow inflammation and received a platelet-rich plasma injection from Andrews.

Sale endured his worst season as a starter since he joined the White Sox rotation in 2012. He took the mound just 25 times, a career low, and posted a 4.40 earned-run average that stands as his highest. Sale finished outside the top six of the American League Cy Young voting and was not named an A.L. All-Star for the first time in seven years.

Sale is entering the first year of a five-year, $145-million extension he signed with the Red Sox late in spring training last season. Should the test results confirm the worst and force Sale to have Tommy John surgery, he would miss all of 2020 and perhaps some of the beginning of 2021. He counts for $25.6 million against Boston’s Collective Balance Tax.

Sale’s first season with the Red Sox was arguably the best of his career. He posted a 2.90 ERA over 32 starts and struck out 308 in just 214 1/3 innings. Sale’s starts, innings pitched and strikeouts have all declined in each of the last two years and bottomed out in 2019. He completed just 147 1/3 frames and fanned 218.

Even a short-term absence for Sale would deal a serious blow to what is a thin Boston rotation. Eduardo Rodriguez, Nathan Eovaldi and Martin Perez are the only real proven major league starters on the Red Sox 40-man roster. It’s almost a certainty Boston will employ the opener at least once every five days and could turn to the likes of Triple-A starters Ryan Weber, Kyle Hart and Mike Shawaryn in an attempt to fill innings.

The Red Sox have already shed one member of their rotation from last season, dealing David Price to the Dodgers along with Mookie Betts in a trade that returned outfielder Alex Verdugo and prospects Jeter Downs and Connor Wong. Boston is now roughly $16.5 million below the first threshold of the CBT per Cot’s Contracts and could add salary in a trade.

Bill Koch writes for the Providence Journal of Gannett.