Orioles LHP Keegan Akin to seek second opinion from Dr. Keith Meister on elbow

Orioles left-hander Keegan Akin is set to meet with Dr. Keith Meister for an evaluation of his elbow next week, per MLB Trade Rumors citing the MLB.com injury tracker. The visit adds a layer of medical scrutiny to what has already been a difficult season for the 31-year-old southpaw, who is currently on the injured list for the second time in 2026.

What happened

Per MLB Trade Rumors, Akin's upcoming appointment with Dr. Meister is the latest development in a season interrupted twice by the IL. His first stint came early, the result of a groin strain that kept him out for roughly the first month of the year. The current IL placement is for an elbow issue, and the second opinion reflects the kind of caution that tends to accompany elbow concerns for pitchers — the joint being, as any baseball fan knows, the one that demands the most careful listening.

Akin is not alone in the Baltimore bullpen's medical waiting room. Also per MLB Trade Rumors, closer Ryan Helsley is undergoing further testing on his own elbow injury this week, and right-hander Colin Selby is scheduled to visit Dr. Neal ElAttrache at the end of the month for an evaluation of an injured shoulder — that detail relayed by Roch Kubatko of MASNsports.com. Both Akin and Helsley recently landed on the injured list, and for both pitchers it marks the second IL stint of the season.

Why it matters

The second-opinion process matters for a few reasons, and not all of them are purely medical. For Akin specifically, the timing carries some contractual weight. Per MLB Trade Rumors, he is in the final year of his arbitration eligibility and playing on a $2.975MM salary in 2026. A second opinion on an elbow injury, mid-season, in a walk year, is the kind of situation that tends to define what comes next — for the player's health first, and for his roster future second.

The performance context makes the picture more complicated. Per MLB Trade Rumors, Akin has posted a 5.68 ERA across 25 1/3 innings this season, accompanied by a 15% strikeout rate. That represents a meaningful step back from the preceding two seasons, during which he combined for a 3.36 ERA and a 27% strikeout percentage. Whether the elbow issue is connected to that decline is not something the available reporting establishes — that remains a question for the medical evaluation, not the box score.

What the numbers do establish is that the gap between this season and the prior two is real and notable. A strikeout rate dropping from 27% to 15% is not a blip; it is the kind of change that tends to prompt questions about whether something mechanical or physical has shifted. The second opinion with Dr. Meister may or may not answer those questions, but it is the appropriate next step given the circumstances.

The numbers

Akin's 2026 season line, per MLB Trade Rumors: a 5.68 ERA across 25 1/3 innings, with a 15% strikeout rate. For comparison, his combined ERA over the two preceding seasons was 3.36, with a 27% strikeout percentage. The salary figure for this season, his final arbitration year, is $2.975MM, per the same report.

Where the club stands

The Orioles enter this stretch of the schedule at 79-82 (.491), sitting fourth in the AL East and 18.5 games out of first place in the division. Baltimore has also been eliminated from the Wild Card race, sitting fifth in that ranking at 4.5 games relative to the cut line. The club arrives at this moment on a one-game losing streak.

The upcoming home schedule at Oriole Park at Camden Yards features the Chicago Cubs on Wednesday with Dean Kremer opposing Colin Rea, and again Thursday with Trevor Rogers facing David Peterson. The Kansas City Royals follow on Friday, with Brandon Young lined up against Luinder Avila.

For a team in this position in the standings, the bullpen's health carries a different kind of weight than it would in a pennant race. The question is less about October and more about what the organization learns between now and the end of the regular season — about which arms are healthy, which are not, and what the roster looks like heading into the offseason.

What we don't know yet

The most significant unknown is what Dr. Meister's evaluation will find. A second opinion on an elbow injury can produce a range of outcomes, and the available reporting does not characterize the severity of Akin's current issue beyond the fact of the IL placement and the upcoming appointment. No timetable for a return has been reported.

The reporting also does not establish a causal link between the elbow and Akin's performance decline this season. That may be a reasonable inference for a reader to draw, but it is not a claim the available material supports, and the desk is not in the business of drawing inferences that the reporting has not made.

The status of Helsley's further testing and Selby's end-of-month visit with Dr. ElAttrache are also unresolved. Those evaluations are pending, and their outcomes are not yet known.

What to watch

### Will Akin return this season?

No timetable has been reported. The next concrete development will be the result of the evaluation with Dr. Meister, which per MLB Trade Rumors is expected to take place next week. What that visit produces — and whether it leads to additional steps — is the thread to follow.

The broader question for Baltimore's bullpen is how the cluster of elbow and shoulder evaluations resolves across Akin, Helsley, and Selby. Three relievers seeking medical opinions in overlapping windows is the kind of situation that shapes roster construction decisions, both for the remainder of this season and for what the organization builds heading into the offseason. The desk will update as the evaluations produce results.

For Akin specifically, the walk-year context means the second opinion carries implications beyond the immediate. Per MLB Trade Rumors, the combination of underperformance and injury appears likely to affect his path forward — though the report stops short of specifying what that path looks like, and so does the desk.