Nationals pitcher Stephen Strasburg likely faces Tommy John surgery for torn elbow ligament

By Dave Sheinin
Washington Post Staff Writer
Saturday, August 28, 2010; 12:29 AM

For months, anyone who would peer into Stephen Strasburg's future, wondering aloud what heights the Washington Nationals' phenom might reach, what pitching records he might break, would use the same cautious qualifier: Strasburg, they would say, could be one of the all-time greats . . . could be a Hall-of-Famer . . . could win 300 games . . . if he stays healthy.

But he did not stay healthy. Strasburg, the same pitcher who was a vision of youthful vitality and athletic genius in the first few glimpses of him on the Nationals Park mound this summer, will have his right elbow sliced open by a surgeon's knife in the next few days. He won't pitch again in 2010. He is unlikely to pitch in 2011.

He may still do all the things that were predicted for him. He may still be the one who fills the stadium, lifts the woeful Nationals franchise to prominence, puts Washington in the World Series. But that vision just got a little fainter.

Strasburg, 22, has had a torn ulnar collateral ligament diagnosed. He will leave Saturday for Southern California, where he will be seen a day or two later by noted orthopedist Lewis Yocum, who is expected to perform the operation - involving the replacement of the torn ligament with one from a cadaver or another part of Strasburg's own body. It is commonly known as Tommy John surgery, for the pitcher who first underwent the procedure in 1974.

"This is a minor setback," Strasburg said late Friday afternoon. "But in the grand scheme of things, it's just a blip on the radar screen."

And so, the story of Washington's Summer of the Phenom can be told in two pitches, the first and the last.

The first pitch came at 7:05 p.m. on June 8, under a pristine sky, in Strasburg's hotly anticipated major league debut at Nationals Park. It was met by the near-unison clicking of cameras. It was a fastball, 97 mph. After smacking into the catcher's glove, the ball was handed off to a man in a suit and white gloves, then whisked away for posterity. Strasburg struck out 14 Pittsburgh Pirates that night. A pitcher has never looked more powerful, or his career brighter.

The last pitch came on Aug. 21 at 9:40 p.m., at Citizens Bank Park in Philadelphia. It was a change-up, 90 mph. As soon as Strasburg threw it, his face broke into a grimace: Pain. He looked at his arm. He shook his hand. He beckoned the team trainer to the mound. He was finished - for the night and, as it turns out, the season. Probably next season, too. Recovery time from this procedure is generally 12 to 18 months.

Although the news feels devastating to the thousands of fans who had come to build their television-viewing or ticket-buying routines around Strasburg's every-fifth-day schedule, the long-term prognosis is not terrible. Elbow blowouts are commonplace among pitchers, and ligament-replacement surgery has been perfected to the point where the Nationals can feel reasonably confident of Strasburg's eventually returning as good as new.

"What we're dealing with here is something that's very manageable," said Scott Boras, Strasburg's agent. "I've had so many clients who pitched until they're 40 have issues like this in their early 20s. I've had a number of clients who feel fine and then, boom, [the elbow] goes, and then they have [the surgery] and they come back and they're fine. As a matter of fact, in the majority of cases they're better."

Everyone in baseball knew this was a possibility. The Nationals certainly knew it when they chose Strasburg, arguably the greatest college pitcher of all-time, with the No. 1 overall pick of the 2009 draft, then gave him a record-setting contract of $15.1 million. They knew it when they sent him out for a minor league apprenticeship - a month in Class AA, a month in Class AAA - with strict pitch counts and innings limits governing his usage.

"Stephen doesn't want any funeral type of thing," Nationals General Manager Mike Rizzo, who charted the conservative course for Strasburg's development, said on ESPN 980. "Tommy John surgery isn't open-heart surgery. We're going to see him a year from today. He's gonna be bigger and better than ever. He's focused on the surgery and the rehabilitation and getting back here. . . . There's no wake here."

The Nationals said their doctors believe it was one pitch, as opposed to an accumulation of wear and tear, that tore Strasburg's elbow ligament - and if so, it was almost certainly that fateful change-up he threw to Philadelphia Phillies right fielder Domonic Brown in the fifth inning on Aug. 21.

Though Strasburg felt good enough to pitch even as he walked off the mound - and even though a similar episode that occurred to him at San Diego State apparently caused no injury - an MRI exam taken Sunday showed a possible tear in the ligament, a diagnosis that was confirmed Thursday by an arthrogram.

The Nationals knew of the confirmation by Thursday afternoon, but according to Rizzo, Strasburg asked that the news be held until Friday, so as not to overshadow the team's introduction of Bryce Harper at Nationals Park. Harper, a 17-year-old outfielder taken with the first pick of the 2010 draft, is the new Strasburg, the new phenom, the new hope.

Later Thursday night, the Nationals played the St. Louis Cardinals in a game started by two Tommy John survivors: the Cardinals' Chris Carpenter (surgery in 2007) and the Nationals' Jordan Zimmermann (2009). All around baseball, in fact, are examples of successful pitchers whose elbows blew out and were patched back together. Ten of them appeared in last month's All-Star Game.

"When I see [some of] these pitchers throw, I'm almost more surprised when they don't end up in surgery," said Nationals Manager Jim Riggleman. "So many of them break down. . . . If you put 12 names in a hat, three of them are going to have surgery."

It is natural to look for an explanation for Strasburg's injury. Did the Nationals monitor his usage the right way? Were his pitching mechanics faulty? Did the shoulder stiffness he experienced in late July, which sidelined him for a little more than two weeks, make him alter his delivery and compromise the elbow? These questions and others were being asked Friday around baseball, in the blogosphere and around Nationals Park.

In the end, though, the only suitable explanation is the simplest one: "Pitchers break down," Rizzo said in a conference call with reporters. "Pitchers get hurt. . . . This player was developed and cared for the correct way. [Are we] frustrated? Yes. Second-guessing ourselves? No."

Strasburg said it took him a matter of hours to come to grips with the diagnosis, before resolving to dedicate himself to rehabbing his elbow with the same competitive edge he previously applied to obliterating hitters.

"If I keep looking for an explanation, it's just going to eat at me," Strasburg said. "I've got to let it go. I've just got to move on. . . . This is obviously a test for me. I want to be the best at everything. Right now, I want to be the best at rehabbing."

If anything, Strasburg may have been undone by his own physical gifts, his own greatness. The fact is, the incidence of elbow blowouts gets higher the harder a pitcher throws. And almost nobody throws harder than Strasburg.

"There's a direct relationship between the velocity and the risk to the UCL," said Benjamin S. Shaffer, the Nationals' team physician from 2006 to '08 and a renowned expert on sports injuries. "Guys who throw 99 to 100 [mph], those guys have a statistically higher risk of elbow injury than those who throw 93, 94. That's published, public data. [Pitching] is a violent act. It's not really physiologic. There are a lot of stresses, and it leads to some elbows and shoulders not holding up under that stress."

The only reason Strasburg's elbow blowout seems bigger is because he was a bigger star - the most hyped pitcher in generations, the most fascinating young player in baseball, the most significant piece to arrive in Washington since the Nationals moved here in 2005.

This injury doesn't make Strasburg a bust. It makes him a cautionary tale.

"Pitching phenoms are born to break your heart," columnist Thomas Boswell wrote in The Washington Post on March 24, 2009 - 21/2 months before the Nationals drafted Strasburg. "Here's the question for the Nats: Do they fall for the scariest words in investing: 'It's different this time.' "

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