Moore played catch with head athletic trainer Ron Porterfield prior to Monday's Rays-Orioles game at Camden Yards. That session told the left-hander surgery was the answer.
"With the way the game of catch went yesterday, being uncomfortable almost every throw," said Moore, noting that he felt pain in his elbow after throwing his curveball and fastball, and not just his changeup.
Knowing his fate seems to have given Moore some peace.
"I guess knowing which way we're going to go, one way or the other, at least I'm not stuck in that limbo," Moore said. "And that's kind of where I was the last couple of days."
Once considered a radical surgery, Tommy John surgery now is considered almost routine due to the many success stories of pitchers who have had the surgery.
"I think that's probably a contributing factor for why we chose to go ahead with the surgery as opposed to if this was 15, 20, 30 years ago, it's probably just a lot of rest and seeing how it feels after all that time," Moore said.
According to data from the Hardball Times website, of the 293 Tommy John surgeries performed on Major League players, only five have been on the Rays: Moore, right-hander Jason Isringhausen (June 16, 2009), right-hander Tyler Walker (2006), right-hander Seth McClung (2003) and right-hander Dave Eiland (2001 and 2002).
Moore and McClung are the only homegrown Rays Major Leaguers to undergo Tommy John surgery.
Moore, who went 17-4 with a 3.29 ERA in 27 starts in 2013, started for the Rays against the Royals on April 7 and seemed to be finding a groove when he entered the fifth inning. With one out he grimaced after throwing a changeup to Nori Aoki that made the count 2-2. Moore then wiggled his left arm in obvious discomfort before a mound conference that included manager Joe Maddon and assistant athletic trainer Paul Harker. Shortly thereafter he left the game.
On April 8, Moore's first MRI of the week did not paint a clear picture of his injury. Later that day, the Rays placed him on the 15-day disabled list and scheduled his visit to Pensacola, Fla., to renowned orthopedic surgeon Dr. James Andrews.
Based on the results of Moore's second MRI in Pensacola, the Rays debated whether he should have surgery or try rehabbing the injury since he did not have a complete tear of the UCL.
Monday's catch session was to have been a determining factor for the final decision.
Rays executive vice president Andrew Friedman said Moore's injury did not make for a cut and dry decision.
"Most other elbow situations that I've encountered have been much more binary where it's either the guy needs to have Tommy John or not," Friedman said. "... This is one of the first ones I can remember that was much more in the gray area.
"...There was definitely some disruptions. There was not a complete tear. So we spent a lot of time over the weekend consulting with Dr. Andrews and Dr. [Koco] Eaton and trying to figure out risk reward, what made the most sense."
In the end, Friedman said the decision came down to how Moore felt. When the throwing session didn't go well, the call became easier to make.
"At that point, it became inevitable and then it was about how do we preserve as much of the 2015 season as we can," Friedman said. "So we decided to go ahead and go the surgical route."
Friedman could not give a definitive answer for how long Moore will be out.
"It's really something, once he goes through surgery and Dr. Andrews has a chance to really get inside the elbow and see what all was affected and how the surgery goes, and then the rehab process," Friedman said. "Surgery is about 10 percent of it and the rehab process is about the remaining 90. It's everything to this."
Friedman stressed that the Rays are confident about Moore making a strong recovery based on Moore's work ethic coupled with the quality of the Rays training staff.
Without Moore, Alex Cobb and Jeremy Hellickson, who all are currently on the disabled list, the Rays' starting rotation includes David Price, Chris Archer, Cesar Ramos, Jake Odorizzi and Erik Bedard.
Friedman said that the Rays are "always watching what's going on in the industry and assessing other teams" as far as possibly going outside the organization to bolster the rotation, but he quickly added: "But I can't imagine that we'll be able to line up on something that will give us a better chance to win than what we have.
"We've got a number of guys we like who are up right now and we have a number of guys in Triple-A. We always talk about there's no such thing as too much pitching. And unfortunately, we're kind of living it firsthand right now. Usually they're spaced out a little more. But I do feel like we have the depth to withstand this and that we have guys who can put us in a position every fifth day to win a game."
Moore earned American League All-Star honors last season, his second full season in the Major Leagues. He will finish the 2014 season at 0-2 with a 2.79 ERA in two starts.
Friedman echoed the sentiments inside the Rays' clubhouse when he talked about the team's recent adversity.
"We'll get through these injuries and hopefully at the end of the year we'll be in a position to do some special things and this will just be one chapter of the story of the 2014 season," Friedman said.