"I never went through this with a player before," Nationals general manager Jim Bowden said by phone. "If this doesn't work, surgery is the next option."
Patterson did not return phone messages on Saturday evening. There is no timetable as to when Patterson will play a Major League game.
Last Saturday night, Patterson announced that he had suffered a major setback earlier that day when had to quit his bullpen session because he felt pain in his right elbow and biceps.
Patterson was working on fixing his mechanics in the session, and he tried to go all out by throwing his fastball. That's when he had to stop.
At the suggestion of his agent, Patterson went to visit a team of doctors to find out what the problem was. He saw Drs. John Conway (Arlington, Texas), Lewis Yocum (Anaheim, Calif.), Gordon Brodie (San Jose, Calif.) and Rod Thompson (St. Louis).
Since being placed on the disabled list, Patterson has been having neck massages in order to get rid of the nerve problems in the elbow. Patterson had indicated in the past that the treatment was working.
"I just can't continue to go the way that I'm going right now. We are going to get some second opinions and see if we can get the problems fixed," Patterson said last week. "We haven't been able to get answers so far.
"Throughout this whole process, it has never really gone away. There were days that were better than others. I think what we have been doing has been helping the situation a little bit. It's just hasn't completely gone away. We are burning time right now. We have done what we can do here."
Patterson was expected to be the ace of the Nationals' pitching staff in 2007, but he pitched in only seven games and went 1-5 with a 7.47 ERA.
This is the third time in four years in which Patterson has had a major injury as a member of the Nationals/Expos. In 2004, he missed more than two months because of a right groin strain. Last year, Patterson missed most of the season because of a right forearm strain, which was surgically repaired.
"I expect him to come back, but I don't know when," manager Manny Acta said. "I'm not basing my team on Patterson. We go along with what we have here. He has been out for a long period of time."
Going to Church: This season marks the first time that left fielder Ryan Church has not missed significant Major League time because of injuries or being in the Minor Leagues. Entering Saturday's action, Church was hitting .260 with seven home runs and 35 RBIs, matching his RBI total from 2006.
Church recently had a talk with Acta, who said he wanted Church to take more advantage of when he is ahead in the count. The team would like him to generate more power.
During the month of June, Church has only three walks. During the first two months of the season, he had a combined 27 walks and was among the team leaders in on-base percentage.
Asked to critique himself, Church gave his usual honest evaluation.
"It's just OK," Church said. "I had a chance to sit down with Manny. He knows the kind of player that I am and he wants to see a little bit more power, be more selective and not give in. It seems like I get myself out on the pitcher's pitches."
Stats of the day: Entering Saturday's action, the Nationals were hitting .252 (171-for-679) against left-handed pitching and .247 (500-for-2024) against right-handed pitching.
Did you know: Entering Saturday's action, the Nationals/Expos are 7-11 at PNC Park, while the Expos went 113-129 at Three Rivers Stadium.
Coming up: The Nationals will play the final game of a three-game series against the Pirates on Sunday afternoon. Washington left-hander Mike Bacsik will face Pittsburgh left-hander Paul Maholm in the 1:35 p.m. ET start.