There is grave concern.
"Of course, I'm worried," Amaro said. "I have to be worried. He's had nicks and knacks, but this is a little bigger than that."
Amaro said the team's doctors did not immediately recommend surgery because it is unclear whether these "changes" are new developments. Adams underwent labrum (cartilage) surgery in October 2008 and did not return until June 2009. On Tuesday he will see Neal ElAttrache, the Los Angeles Dodgers' orthopedist who performed Roy Halladay's shoulder surgery.
"It may be something new; it may be something old," Amaro said. "They are still working on determining that."
Adams complained of biceps soreness shortly after returning from a strained back in May. Dubee wanted Adams to pitch in two minor-league rehabilitation outings before his activation, but the pitcher declined that assignment. Amaro watched Adams pitch to hitters in Clearwater, Fla. The pitcher and GM determined he was healthy.
Adams had a 5.40 ERA in 11 games between DL stints.
"I talked to him directly," Amaro said. "I saw him throw. He felt like he was ready to go."
Now he is on the DL with relievers Michael Stutes and Jeremy Horst. In Adams' absence, the Phillies are searching for any answer. They recalled Phillippe Aumont after Sunday's game. Five of the current seven Phillies relievers have spent time at triple A in 2013. Aumont holds great promise, but mental roadblocks remain.
After his demotion in late May, Aumont criticized the team for sending "mixed messages." He apologized by calling coaches and front-office officials.
"I felt bad, especially for the people who were trying to help me," Aumont said.
Justin De Fratus will assume Adams' role, for now. But there are no guaranteed jobs in the majors' worst bullpen in terms of ERA (4.67) and inherited runners scored (40 percent).
"It's probably the youngest we've had," Dubee said. "Even at the start, it was young. Michael was a question mark coming in after the surgery. We felt good about the three guys at the back end. . . . That's a crapshoot in baseball; trying to find the right bullpen pieces. After wear and tear, sometimes you don't know what you're going to get."
Contact Matt Gelb at firstname.lastname@example.org. Follow on Twitter @magelb.