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Stephen Strasburg has flexor mass strain, ‘not a season-ending’ injury

Washington Nationals trainer Paul Lessard escorts starting pitcher Stephen Strasburg off the field on Sept. 7. (Alex Brandon/Associated Press)

Stephen Strasburg’s ulnar collateral ligament is intact. The Washington Nationals pitcher does not need another Tommy John surgery. His season may not be over yet, though it might be, because Strasburg — who left Wednesday night’s game in the third inning after feeling a “pinch in the back of his elbow,” according to his manager — does have a strain of the flexor mass in his right elbow, and his timetable for a return is unclear.

Nationals Manager Dusty Baker said he “did a lot of praying” Wednesday night that the injury was not as bad as it could have been. Thursday, he agreed it was accurate to call this news the best-case scenario. When pitchers have elbow pain, something is wrong. If something is wrong, better a flexor mass strain than something worse — though the Nationals will follow team protocol and send Strasburg to orthopedic surgeon Neal ElAttrache of the Yocum group for a second opinion, according to a person with direct knowledge of the situation.

“Everybody’s pretty satisfied of where we are at this point, and it’s very good to know,” Baker said. “Exactly the timetable we don’t know, but it’s good to hear that it wasn’t what everybody was speculating that it was.”

Trainer Paul Lessard delivered the news to reporters in an unorthodox meeting around 4 p.m. Thursday, an hour or two after the Nationals got the results of Strasburg’s second MRI exam this season. Lessard had never addressed the D.C. media, and his opening statement was a memorable one.

“I know everyone was concerned that he re-injured that Tommy John ligament, and the answer is no,” Lessard said. “The ligament is good.”

What isn’t good is Strasburg’s flexor mass, which Lessard described as being on the inside of the elbow. Flexor tendons run down through the wrist and flex fingers, and therefore are called upon “anytime you flex your wrist or pronate your wrist,” Lessard said. All those flexors attach in one place on the inside of the elbow, a place where a lot of things converge — including the ulnar nerve — which means pain in that area can be confusing, scary and hard to pin down.

Strasburg had been dealing with right elbow discomfort for the last three weeks, enough of it that the Nationals placed him on the disabled list. Forty-two pitches into his first game back, he was walking off the mound with more discomfort, though Lessard said this pain was different than the swelling in the “posterior” of the elbow that caused that disabled list stint.

Strasburg did not undergo an MRI for that August discomfort because the Nationals did not see any signs of lingering trouble in his delivery or velocity. He had an MRI before he signed his seven-year, $175 million extension in May, and Lessard did not see any major differences between Thursday’s MRI and that one.

Importantly, Lessard also identified the injury as “an acute injury, versus an overuse injury.” In other words, the official word from the Nationals is that Strasburg suffered this particular injury on that pitch to Mike Foltynewicz on Wednesday.

So what does this mean for the rest of Strasburg’s season? The Nationals, as represented by Lessard, Baker and a team spokesperson, were careful not to say. Lessard did say that the next four or five days would be crucial as the timeframe in which he and his staff would hope to reduce inflammation and help Strasburg regain “pain-free range of motion.” But Lessard would not project much from there.

“Normally, [these injuries] come around very well with treatment and strengthening programs,” Lessard said. “It’s not a season-ending injury, but we still need to take time that he’s nice and strong because of his past.”

But if strained flexor masses are not normally season-ending injuries, this one still could be because this season is ending soon. Game 2 of the National League Division Series is scheduled for one month from Thursday. Could Strasburg be ready?

Quick research indicates injuries like these require rest, often a few weeks’ worth. The longer the rest, the longer the rebuild, because starters require stamina, which requires time.

History provides no definitive lessons about exactly what an injury like this might mean. Indians reliever Andrew Miller landed on the disabled list with a strained flexor mass on June 10 of last season and returned July 8. Mat Latos, then a starter for the Reds, suffered a flexor mass strain in April 2014 and returned in June. That same year, Latos’s teammate Homer Bailey saw his season end because of a strained flexor mass that eventually required surgery. He underwent Tommy John surgery the next spring. Lessard was the trainer in Cincinnati at the time.

Red Sox right-hander Carson Smith hit the disabled list with a strained flexor mass in March. He had Tommy John surgery in May. When Strasburg initially injured his elbow in 2010, the initial diagnosis was a “strained flexor tendon.” A few weeks later, the Nationals announced that he had torn his ulnar collateral ligament and required Tommy John surgery.

Given all that, perhaps the only helpful lesson history can contribute to Strasburg’s situation is that the Nationals will be careful with him. They shut him down amid widespread consternation in 2012. He did not pitch in the All-Star Game in his home town this season because he had recently returned from the disabled list. Baker pulled him out of a game in which he was throwing a no-hitter earlier this season because his pitch count was so high. They placed him on the disabled list in August for what they described as precautionary reasons.

If Strasburg cannot return, whether because he is not healthy in time to do so or because the Nationals do not want to risk pushing him, the Nationals have a major hole in their potential playoff rotation. But they do not know who exactly will fill it, nor whether they will have to fill it at all.

“We have the personnel that we have. You can’t count on somebody else coming in here,” Baker said. “So we have to do is the best for the situation with what we have, and then make a determination on who is to take his place now and possibly later. Or is it a better option to not have Stephen, or do we not count Stephen out?”

More on Strasburg’s latest injury:

Strasburg exits early — into a future of swirling uncertainty

People are quick to blame Strasburg’s latest setback on Dusty Baker

Steinberg: Strasburg injury is a feeling too familiar

What happens to the Nationals’ rotation now?