PITTSBURGH -- Los Angeles Dodgers reliever Hong-Chih Kuo was placed on the 15-day disabled list for the second time this season and the sixth time in his major league career on Wednesday because of anxiety disorder.
Dodgers manager Don Mattingly said the veteran left-hander told him following a dismal performance against the Pittsburgh Pirates on Monday his confidence was shaken.
"He couldn't put the ball where he needed to," Mattingly said after a 2-0 win over the Pirates on Wednesday. "That's pretty much what he said. I listened to him, and I have so much respect for him, after all he's been through. It's just one of those things."
Kuo was expected to return to Los Angeles late Wednesday night. He will undergo a series of tests in the coming days.
To fill Kuo's spot in the bullpen, the Dodgers recalled left-hander Scott Elbert from Triple-A Albuquerque.
The move came just three days after Mattingly announced he would treat Kuo, at Kuo's request, just like any other reliever after Kuo was handled with extreme care for years because of his history of medical problems, a history that included two Tommy John elbow reconstructions before he reached the major leagues in 2005.
Through Monday, Kuo had pitched three times in four days. For the season, he has an uncharacteristic 11.57 ERA in nine appearances and an even more uncharacteristic six walks in 4 2/3 innings, albeit with eight strikeouts. Kuo said Tuesday that he felt fine physically and that he wasn't sure why he had been struggling so much with his command, and Mattingly said Tuesday that Kuo continued to tell team officials he felt fine physically.
"When you're talking about Kuo, he is basically always hurting," Mattingly said Wednesday. "It's just at what level. His elbow is always hurting. It never goes away, really. It's just how much he can deal with. It is always there. ... When I say he doesn't complain, it means that in talking with [trainer] Stan [Conte], when he says he is good to go, that means he can deal with it. His 'I'm OK to go' is different than being 100 percent.
"But he isn't good to go [now]."
Mattingly offered a definitive "no," when asked if Kuo was retiring, but he was noncommittal on whether Kuo might pitch again anytime soon.
"It's heartbreaking, but I just don't know where it goes from here," Mattingly said. "At this point, it's a medical decision."
Kuo wasn't seen at the park before Wednesday night's game with the Pirates. Mattingly said that Conte had a schedule mapped out for Kuo when he got to Los Angeles.
Dodgers general manager Ned Colletti, who isn't traveling with the team, declined to comment publicly or to disclose any additional information when reached on his cellphone. Alan Chang, Kuo's Chicago-based agent, didn't immediately return voicemails left by ESPNLosAngeles.com on two different phone numbers listed for him.
Kuo spent almost three months on the disabled list in the middle of the 2009 season with what officially was termed left-elbow inflammation. It later was revealed that he spent much of that time trying to overcome a case of the "yips,'' in which he couldn't control where the ball was going after it left his hand.
Kuo, 29, had the best season of his career last year, posting a 1.20 ERA in 56 appearances and a strikeout-to-walk ratio of better than 4-to-1, all of which helped him earn a spot on the National League All-Star team for the first time. In his most recent outing with the team, he relieved Chad Billingsley with nobody out in the eighth inning on Monday night against the Pirates, faced two batters and gave up RBI doubles to both of them.
Los Angeles pitcher Hiroki Kuroda said he was "concerned" about his teammate and acknowledged undergoing a crisis of confidence as a younger player.
"I've been through something similar in the past like that in high school and in college," Kuroda said. "I tried everything. I talked to a lot of people, but it really depends on the player. ... At this point, we just have to play with what we have, and just pray that he comes back real soon."
Meanwhile, reliever Blake Hawksworth will avoid the disabled list -- for now, anyway -- after an MRI exam on his right groin showed nothing serious.
Hawksworth, who left Tuesday night's game after facing three batters when his groin tightened up while throwing a pitch, said he is planning to try throwing off a mound by Friday and then be ready to return if that goes well.
"There is no swelling or fluid, which is what I kind of anticipated last night," said Hawksworth, who had a similar injury a little more than a year ago that he says was more severe than this one. "I'm not going to do anything today except take treatment. I'll play catch tomorrow and hopefully get on a mound Friday."
However, Mattingly said that if Hawksworth isn't available in the next few days, the team likely will place him on the 15-day disabled list rather than operating a man short in the bullpen.
Tony Jackson covers the Dodgers for ESPNLosAngeles.com. Information from The Associated Press was used in this report.