Stephen Strasburg will need Tommy John surgery

Stephen Strasburg has a significant tear in his ulnar collateral ligament that will probably require Tommy John surgery, Nationals general manager Mike Rizzo said this morning.

Strasburg, who came out of last Saturday’s game against the Phillies in the fifth inning after throwing a changeup to Domonic Brown, was initially diagnosed with a strained flexor tendon in his right forearm. He was examined in Philadelphia last Saturday, and a Phillies team doctor told the Nationals that Strasburg would be fine, and would be throwing again in five days.

But a subsequent MRI showed enough swelling in Strasburg’s arm to merit the MRI arthrogram, in which dye is injected into the area of the patient’s injury. That test showed the tear of Strasburg’s ulnar collateral ligament. The Nationals will fly Strasburg to the West Coast to get a second opinion from Dr. Lewis Yocum, but after two MRIs and opinions from multiple doctors, Rizzo is confident Strasburg will need Tommy John surgery, and said he will have the surgery “as soon as maybe the next day” after Yocum’s examination.

“We’ve got the dry MRI, we’ve got the MRI arthrogram, we’ve got two different doctor’s opinions,” Rizzo said. “We feel it should be a typical Tommy John rehabilitation, and this is going to be no different.”

The injury strikes quite the blow to the Nationals, both because of what Strasburg already meant to their rotation and because of how carefully the Nationals feel they developed him. They were planning to limit Strasburg to 150-160 professional innings this season, and had let him finish seven innings in the majors just twice. He did not reach 100 pitches in any of his 12 starts.

“Yes, it’s frustrating, because the injuries happen to people you think they shouldn’t happen to,” Rizzo said. “This player was developed and cared for in the correct way. Things like this happen. Pitchers break down, pitchers get hurt. But we’re certainly not second-guessing ourselves. We’ve developed a lot of pitchers this way. We’re satisfied with his development. Scott Boras is satisfied with his development, and I know Stephen is as well. So we’re good with that - frustrated, yes, second-guessing ourselves, no.”

Rizzo said it’s difficult for doctors to tell exactly when the tear happened, but added they believe it happened on one particular pitch. Strasburg held his elbow and shook his hand a few times after throwing the pitch to Brown, but told manager Jim Riggleman he had felt a similar pain at San Diego State and stayed in the game.

On Friday, Rizzo described what Strasburg said he’d felt at San Diego State as “a little grab,” and characterized the pain he felt on the pitch to Brown as something different.

And team president Stan Kasten said part of the difficulty in diagnosing Strasburg was that the 22-year-old himself was saying he “still felt pretty good.”

The Nationals told Strasburg the news on Monday, with his agent, Scott Boras, in town for Bryce Harper’s introductory press conference. Kasten said Boras shared a long list of his clients who’d come back successfully from Tommy John surgery. And the list is certainly filled with big names: former Cy Young winner Chris Carpenter, who pitched for the Cardinals last night, has had it. So have the Braves’ Tim Hudson and Billy Wagner, the Yankees’ A.J. Burnett, the Cubs’ Ryan Dempster, the Twins’ Francisco Liriano and the Giants’ Brian Wilson.

Jordan Zimmermann, the Nationals’ top pitching prospect before Strasburg was drafted, also had it last year, and made his big-league return last night, just over 12 months after the surgery. He faced Carpenter in the Nationals’ 11-10 win.

Rizzo and Kasten both said Strasburg was upset when he first heard the news, but quickly turned his focus to rehabbing well and getting back to the majors. If he came back as quickly as Zimmermann did, it’s not out of the question Strasburg could be pitching in the majors next September. But a 2012 return seems more likely.

Strasburg ends his rookie season with a 5-3 record, a 2.91 ERA and 92 strikeouts in 68 innings.

“I was in the room while the others were talking to him. I was with him in the room Monday when these questions first arose,” Kasten said. “He was upset Monday.This is tough news for a kid with this kind of future and the high expectations he puts on himself. This is a high-achievement oriented kid. Yeah, it’s a tough day for him and for all of us and for everyone who’s a Nats fan. But we still have Jordan coming back, and a year from now, we’ll have Stephen and the other 24 guys. It’s easier for us today than it was Monday, and i think for all our fans and our teammates, it’ll be easier than it is today.”