TORONTO -- The Orioles got some devastating news regarding Adam Loewen on Tuesday, when they revealed that the southpaw had re-aggravated the stress fracture in his left elbow that caused him to miss almost all of last season. Loewen, who had surgery to repair the last stress fracture, is weighing his options for how to treat it this time.

Loewen left Sunday's game early, but the severity of the ailment wasn't released until Tuesday. Loewen has already been examined by Dr. Jon Wilckens and will talk to noted orthopedist Dr. James Andrews to determine a course of action.

"I spoke to him today," said Baltimore manager Dave Trembley. "He's going to rest. He's talked to [team physician] Dr. Wilckens and we're going to consult with Dr. Andrews to come up with the next course of action. Like I said on Sunday, he's not going to pitch for a while. He sounded better today than when I talked to him after the game on Sunday.

"My concern right now is to see what Dr. Andrews says, consult with Dr. Wilckens and then go from there."

Loewen originally suffered the stress fracture in 2007 and missed virtually all of the season after corrective surgery that inserted a screw to stabilize the joint. Trembley said that the recent tests show that the stress fracture has widened, which could result in another corrective surgery that would require the same amount of rest and rehabilitation.

And even after it's done, Loewen would still have to learn to pitch with the injury all over again. Trembley acknowledged the extent of the ailment but insisted that the Orioles haven't really considered how to best correct the problem.

"I'll be honest with you," he said. "I don't know. Adam wants to have a few days to think about this. He's not in a hurry right now to do anything. I asked him if he was going to go to Birmingham to talk to Dr. Andrews and he said no. He's going to talk to him on the phone. After he talks to him on the phone, I think they'll have some kind of plan."

Loewen, a former first-round Draft pick, was treated extra carefully this season. The Orioles shut him down after a few starts after the left-hander complained of elbow discomfort, and he went through a step-by-step rehabilitation program through the Minor Leagues. And after he graduated from that schedule, Trembley called him to ascertain his health.

The manager told the pitcher that he didn't want him coming back if he felt anything at all in his arm, and he went the extra step of telling the media that Loewen would only be used in relief for the rest of the season. That caution didn't stop the worst-case scenario from developing, but Trembley said he believes that Loewen was truthful with him all along.

"He told me -- and I have to believe what he said -- [that] he never felt anything in his arm when he rehabbed," said Trembley, describing his phone conversation. "He didn't feel anything when he pitched. The pitch before that I took him out of the game, he said was the first time he felt something. It's just a real, real unfortunate situation."

Loewen declined comment on Sunday, and Trembley said Tuesday that he was disconsolate behind closed doors. Loewen's outlook has brightened a little, but Trembley said he's not in a rush to get the next diagnosis. And neither are the Orioles, who have already lost left-hander Troy Patton and right-hander Matt Albers to slight tears in their pitching shoulders.

"It's not the way we drew it up," said Trembley. "It's part of the game. It would've been just all fine and dandy if no one got hurt, but we had some people get hurt. It's going to give some other people an opportunity. We're going to have to do a better job as managers, coaches and players to pick up for those guys that have been hurt."