Stephen Strasburg has a torn elbow ligament and will likely have Tommy John surgery, bringing the pitcher's promising rookie season to an abrupt end.
Washington Nationalsgeneral manager Mike Rizzo said Friday an MRI on the right elbow revealed a "significant tear." Strasburg will travel to the West Coast for a second opinion, but Rizzo anticipates the 22-year-old right-hander will need the operation that requires 12 to 18 months of rehabilitation.
"As you can imagine, he was initially upset," Rizzo said. "But he has really turned himself from being upset to being focused on his rehabilitation. He's determined to get the surgery done and begin the process of rehabilitation."
Strasburg was pulled from Saturday's game at Philadelphia when he grimaced while grabbing and shaking his wrist after throwing a changeup to Dominic Brown.
The Nationals initially called the injury a strained flexor tendon in the forearm, but an MRI taken Sunday raised enough questions for the Nationals to order a more extensive MRI in which dye is injected into the arm.
The No. 1 overall pick in the 2009 draft, Strasburg signed a record $15.1 million contract a year ago. He struck out 14 batters in a sensational major league debut in June and was quickly drawing huge crowds everywhere, drawing gasps with his 100 mph fastballs, bending curves and wicked batter-freezing changeups.
He went 5-3 with a 2.91 ERA and 92 strikeouts in 68 innings with the Nationals, who have kept him on strict pitch counts and had planned to shut him down once he reached about 105 innings.
But he has had medical setbacks despite the team's best efforts to be as cautious as possible. He was placed on the disabled list a month ago because of inflammation in the back of his right shoulder. He was making his third start since returning from the DL when he had to leave the game against Philadelphia.
"The player was developed and cared for in the correct way, and things like this happen," Rizzo said. "Pitchers break down, pitchers get hurt and we certainly are not second-guessing ourselves. ... Frustrated? Yes. But second-guessing ourselves? No."
Rizzo said doctors believe Strasburg hurt himself on a particular pitch, as opposed to a gradual buildup. When Strasburg grimaced in game at Philadelphia, he told the team he had felt something similar at San Diego State and had continued to pitch through it. Doctors have decided that what happened in college was unrelated to the ligament tear.
Even so, Strasburg has been saying this week he is strong enough to pitch.
"Stephen felt pretty good and still feels OK," Nationals president Stan Kasten said. "And that's why this has been so confounding."
Strasburg is an intense, competitive pitcher. He wasn't thrilled with having to start the season in the minors or with the restrictions the Nationals placed on him. Now he faces the realistic prospect of not pitching again until 2012.
The injury is the last thing the woebegone Nationals needed. The franchise is on pace for its fifth last-place finish in six years since relocating from Montreal, and Strasburg was seen as the centerpiece of the rebuilding. Attendance has been disappointing at Nationals Park since it opened in 2008. Strasburg, however, generated rare sellouts in his first few home starts.
Strasburg was informed of the diagnosis Thursday night, but the Nationals chose not to announce the news because it would have upstaged the introductory news conference for 2010 No. 1 draft pick Bryce Harper.
Coincidentally, Thursday's game marked the return of Jordan Zimmermann, another young Washington pitching prospect who had Tommy John surgery a year ago. His counterpart, Chris Carpenter of the St. Louis Cardinals, has also had the operation.
"I look at the bright side," Rizzo said. "Tommy John surgery is a surgery that we've had great success at. The success rate for guys coming back from Tommy John and retaining their stuff is very good. We saw two examples of it on the mound yesterday at Nationals Park."
Indeed, dozens of major leaguers have had the surgery since Dr. Frank Jobe performed the first one on Los Angeles Dodgers pitcher Tommy John in 1974. It's a procedure in which a ligament in the medial elbow is replaced with a tendon from elsewhere in the body (often from the forearm, hamstring, knee, or foot of the patient).
"That's the modern miracle of what doctors can do to put people back together," Twins manager Ron Gardenhire said recently after a game that featured Tommy John returnees Francisco Liriano and Tim Hudson. "We all know the arm takes a beating. Goodness gracious, we saw two guys who were both throwing the ball 90-plus mph with sliders and stuff. That's because some doctors did some really good jobs."