The mystery of what is going on inside Stephen Strasburg's prized right arm, a question that has left the phenom's season in limbo and the Washington Nationals' brain trust in a state of angst, will endure for at least another 72 hours. Strasburg's absence from a major league mound, meantime, will last at least another two weeks.
Thirteen days after coming off the disabled list following a bout of shoulder stiffness, Strasburg, 22, went right back on it Monday — this time with a forearm/elbow injury suffered Saturday night in Philadelphia. An MRI taken Sunday, while ultimately inconclusive, gave the team enough cause for concern to shut him down, at least temporarily, and order a more detailed exam.
Sunday's MRI, according to general manager Mike Rizzo, showed "something on there that led us to set up another arthrogram MRI, with injected dye, so we can get a full view of what's going on in there."
Rizzo did not elaborate on what the original magnetic resonance imaging showed. Manager Jim Riggleman described it as "less encouraging" than the initial diagnosis given in Philadelphia by a Phillies team physician, who, according to Riggleman, told the Nationals, "He's fine. He'll be pitching in five days."
The arthrogram MRI had not been scheduled as of early Monday evening, but the team hoped to line it up for Thursday.
"For us to do it in 72 hours, it gives us a chance for ... the swelling to go down so we can get a real good picture of it," Rizzo said.
According to a team source, right-hander Jordan Zimmermann, who has been finishing a rehabilitation assignment in the minor leagues after elbow ligament-replacement surgery 12 months ago, will be called up to assume Strasburg's spot in the rotation, beginning Thursday night at Nationals Park against the St. Louis Cardinals.
Rizzo used "elbow" and "forearm" interchangeably when discussing Strasburg's injury, which for now the team is calling a strain of the "flexor mass," which includes a muscle and a tendon that connects to the elbow.
Asked if Strasburg could be shut down for the season, given the fact only about four weeks would remain when he is eligible to return from the disabled list, Riggleman said, "It's just too early to tell. We've got at least 15 days before we would even have to make that decision."
Strasburg, whom the Nationals signed to a record-breaking $15.1 million contract after making him the No. 1 overall pick of the 2009 draft, was at Nationals Park Monday, but remained out of sight of reporters and was not made available to address the media. Asked to describe Strasburg's mind-set, Rizzo said, "To say he's a little anxious, a little emotional, would be fair to say."
Strasburg was in the midst of one of his finest outings of the season Saturday night in Philadelphia when he suddenly grimaced in pain and began shaking his right arm after a 1-1 changeup to Phillies right fielder Domonic Brown, on Strasburg's 56th pitch of the night. He lobbied to remain in the game, but Riggleman and pitching coach Steve McCatty immediately yanked him.
Although forearm injuries frequently portend elbow problems, Strasburg has experienced similar episodes — a sharp pain or tightness that passes quickly — while pitching at San Diego State. Those episodes always occurred on a changeup, and Strasburg was always able to continue pitching.
Strasburg has told Nationals officials he feels fine, and he came to the stadium Monday expecting to throw lightly before the game — a notion the team quickly rejected. "He feels good enough to pitch," Rizzo said.
Nationals lefty John Lannan experienced a similar forearm episode in May and avoided a trip to the disabled list — although he missed one start and eventually fell into poor mechanical habits because of the forearm problem, resulting in a demotion to the minor leagues. Rizzo acknowledged the injuries to Strasburg and Lannan were similar.
"My arm after that wasn't the same," Lannan said. "I tried to pitch through it, and it wasn't working. So they gave me the cortisone shot. ... It felt better. It was just that I picked up some bad habits because I was trying to guard against it. You're going to try to throw where you're not putting as much pressure on it."
As with Strasburg, Lannan's episode occurred on a changeup, which requires extra pressure in the grip while throwing with the same arm speed and force of a fastball. It is a pitch Strasburg threw infrequently in college, but that he worked on extensively beginning in the Arizona Fall League in October, and that now has become a critical part of his repertoire.
"It puts pressure on the tendon that runs down and connects to your elbow," Lannan said. "I can feel it. It's tight. You put a lot of pressure on it, especially [with] Strasburg throwing a 92-mile-per-hour changeup."
Arm injuries, minor and major, are common among young pitchers, particularly those who throw as hard as Strasburg does. Despite the extreme caution with which the organization has treated Strasburg's workload, within the span of four weeks he has had problems with his shoulder and elbow areas.
"The workload we put on them, you hold your breath when they're pitching," Riggleman said. "Stephen is going through a couple things right now. Hopefully it doesn't turn out to be extremely serious. Regardless, there's a couple of red flags."