When Matsuzaka was initially shut down with a sprain in his ulnar collateral ligament, the first step was for the pitcher to take two weeks off and see how his elbow responded. The hope was that the 30-year-old Matsuzaka could return to the mound following an unspecified period of rest and rehab, and that surgery could be avoided.
Matsuzaka -- with the blessing of the Red Sox -- went to Southern California and got a second opinion from Dr. Lewis Yocum on Tuesday.
Boston manager Terry Francona said multiple times following that meeting that, diagnostically, Yocum saw the same thing as the Red Sox doctors.
However, one of the main reasons the club cited for Matsuzaka's visit with Yocum was to get his input on the best type of recovery for the pitcher.
Though the Red Sox and Matsuzaka are still doing some final due diligence, and official plans aren't likely to be revealed until Friday, surgery appears to be the recovery method the sides will choose.
If Matsuzaka has the surgery, he could return to the mound for the Red Sox at some point during the 2012 season.
Billy Wagner, who pitched for the Red Sox in 2009, returned from Tommy John surgery in 12 months. Often times, pitchers need a few months longer than that.
The 2012 season marks the end of the six-year contract Matsuzaka signed with the Red Sox.
Matsuzaka came to the Red Sox after a highly successful career in Japan amid much fanfare. Boston secured negotiating rights with Matsuzaka with a record-setting blind bid of $51.1 million to the Seibu Lions in November 2006. A month later, the club signed him to a six-year, $52 million contract.
Matsuzaka won 15 games in his rookie season of 2007, also notching victories in Game 7 of the American League Championship Series and Game 3 of the World Series, which the Red Sox swept in four games. In '08, he had his finest season, going 18-3 with a 2.90 ERA and finishing fourth in the AL Cy Young Award voting.
Dice-K's career has been on a downward trend since, as injuries and ineffectiveness have been prevalent.
In eight appearances this season -- seven of them starts -- Matsuzaka is 3-3 with a 5.30 ERA. Since the start of the 2009 season, he is 16-15 with a 5.03 ERA.
He last pitched for Boston on May 16, giving up five hits, five runs and seven walks over 4 1/3 innings. Matsuzaka first felt some discomfort in his elbow in his April 29 start against the Mariners. The Red Sox elected to take him out after four innings that night, though Matsuzaka told the club he wanted to keep pitching. He pitched three more times, but wasn't particularly effective in any of those outings.