Neal Huntington says Nick Kingham is getting a second opinion on his injured elbow. This is just speculation at this point, but David Todd suggests that a second opinion on an elbow injury usually means Tommy John surgery. Here's hoping that can be avoided, but I agree with David that's probably what's going on here.
We are, of course, at a point in history when pitchers can often make full recoveries from the sorts of elbow injuries that require Tommy John surgery. But if Kingham does in fact have TJ, he'll be out for about a year.
The Pirates already don't have the depth they otherwise might due to Tommy John surgeries for Brandon Cumpton and Jameson Taillon. The key depth pieces at Indianapolis now are Casey Sadler and Adrian Sampson (EDIT: and there's Clayton Richard, currently rehabbing at Bradenton), and there isn't much beyond that; Chris Volstad, Wilfredo Boscan and Charlie Leesman are only-break-glass-in-emergency types. That means the Bucs' depth is pretty thin, so it really does matter how they handle Charlie Morton's impending return, which will likely bump Vance Worley or Jeff Locke out of the rotation. Both are out of options, and the Pirates will almost surely try to keep the guy who gets bumped in the bullpen. That will be tricky, because he'll have to work multiple innings in case he needs to rejoin the rotation.