A week that already was shaping up to be one of the saddest in the Nationals' recent history was jolted by another dagger of bad news today: Stephen Strasburg needs surgery for neurogenic thoracic outlet syndrome, a potentially career-altering injury.
Strasburg's diagnosis came Monday night after an examination by specialist Gregory Pearl, the same Dallas doctor who performed thoracic outlet surgery on Nationals reliever Will Harris earlier this year.
Unlike Harris, whose condition was caused by a blocked artery, Strasburg has been hampered by a compressed nerve between his neck and right armpit. That's the most common cause of thoracic outlet syndrome and Wednesday's surgery likely will involve the removal of a cervical rib and small muscles to help alleviate the nerve compression.
It's a major injury for pitchers, one that will at minimum sideline Strasburg until sometime in 2022 and could prevent him from ever regaining his velocity and form from earlier in his career.
"Unfortunately these are the steps we've got to take now," manager Davey Martinez said in revealing the news during his Zoom session with reporters prior to tonight's game in Philadelphia. "Hopefully, we get this fixed, and he'll be ready to come back and help us next year. I know he's frustrated, as we all are. But sometimes things don't work out like you want, and we've got to move forward. Hopefully this will help us move forward. At least now, we know what's going on."
The diagnosis comes after two frustrating seasons for Strasburg, who since winning World Series MVP honors in October 2019 has made only seven starts and thrown only 26 2/3 innings, few of them effective.
The 33-year-old right-hander was shut down last summer after experiencing numbness in his pitching hand, with surgery performed for carpal tunnel neuritis. He returned this spring and looked strong both in Florida and during his April 7 season debut against the Braves, but then saw his velocity dramatically drop during his next start in St. Louis, when he gave up eight runs in four innings.
The Nationals placed Strasburg on the 10-day injured list with right shoulder inflammation. He would return six weeks later and again pitch well against the Orioles, then against the Reds before departing a June 1 start in Atlanta in the second inning with diminished velocity once again.
Strasburg went back on the IL with what the club then referred to as nerve irritation in his neck and began the rehab process again. He actually appeared to be making progress in recent weeks, facing live hitters shortly before the All-Star break and throwing both off a bullpen mound and from long distance on flat ground as recently as last week before revealing to the medical staff he was still experiencing discomfort.
The Nationals sent Strasburg to Dallas to be examined by Pearl, and received the disappointing news on Monday evening.
"We all saw him out there throwing long toss at 200 feet. He threw some really good bullpens. So we thought he was progressing," Martinez said. "And then he would come back the next day and he was sore. We couldn't figure it out. He'd work through it and go back out, and again he got back on the mound and he'd get sore again. At some point, him and the medical staff had decided maybe he needs to go get looked at. And that's what we decided to do.
"It's unfortunate this is the route we've got to take right now. You really try everything you can to avoid any kind of surgery. But I hope that when he has his procedure done, he comes back and he's able to rehab and he's able to get back on the mound for us."
Strasburg, who hasn't spoken to reporters since May 27 (following his second-to-last start before his current IL stint), is only in the second year of a seven-year, $245 million contract he signed after opting out the final four years of his previous $175 million on the night of the World Series parade. This deal runs through the 2026 season, with the final check of the $80 million that was deferred from the contract being paid on Dec. 31, 2029.
Strasburg joins a short-but-growing list of major league pitchers who have needed thoracic outlet surgery, and there are few success stories from the bunch. Though most pitchers have been able to return from the injury, only a handful have regained their velocity and effectiveness from pre-surgery.
Among the most notable names on the list are Matt Harvey, Josh Beckett, Phil Hughes, Chris Young, Chris Carpenter, Alex Cobb, Vince Velasquez and Tyson Ross (Joe's older brother).
The No. 1 pick in the country who made one of the most dazzling major league debuts in history on June 8, 2010, Strasburg ranks in the top six among all pitchers who have made at least 200 starts since then in ERA (3.21), WHIP (1.093) and strikeouts per nine innings (10.6).
The issue, as always, has been his ability to make starts every fifth day without interruption. He has topped 180 innings only three times in his career, though he led the National League in 2019 and then went on to produce one of the greatest October pitching runs in postseason history.
"I get to manage him here, and I know what kind of workhorse he is when he's healthy and on the mound," Martinez said. "And what he did in '19 for us, (he's) a big reason why we did what we did and we were able to win the world championship. For him to have all these issues, it's frustrating for him. It's frustrating for us.
"But one thing that I thought about last night is really thinking about him and what he's going through. And when he comes back, trying to be as positive as I can with him. And encourage him to just stay with it and just try to get ready for spring training. Because he still has a lot of years here. And a healthy Strasburg can help us win a lot of games. I'm really pushing for that, I'm hoping for that. And I know he feels the same way."