They are the two words no pitcher wants to hear, but for Washington Nationals phenom prospect Stephen Strasburg, it appears "Tommy John" will soon enter his vocabulary.
The right-hander who took baseball by storm this summer appears headed for surgery, much to the dismay of the Nationals organization and baseball fans alike.
It is a very tough blow for a pitcher that not only the Nationals, but Major League Baseball as well, anticipate will be a star for the next decade.
Here is the latest on the injury concerns regarding baseball's top prospect.
Strasburg left his start on August 21st with what was diagnosed as "forearm tightness."
Strasburg was then sent for an MRI, which originally confirmed a forearm strain. However, a second MRI this week revealed a "significant tear" in the ulnar collateral ligament.
In simple terms, when a pitcher has a tear in the UCL, Tommy John is the end result at least 90 percent of the time.
The Nationals put Strasburg on the disabled list in late July with an inflamed right shoulder. Was that a sign that the Nationals should have shut him down for the season then and there?
While the elbow injury was probably festering for a while, the shoulder injury could have forced Strasburg to compensate with his elbow, which may have exasperated the torn ligament.
After the second MRI and the dye test showed the torn UCL, Strasburg was sent off to see Dr. Lewis Yocum.
When you see Yocum's name pop up for a doctor visit, you know there is a significant procedure likely to be done. Similar to the famous Dr. James Andrews, Yocum is one of the experts in the field when it comes to sports-performance surgeries.
Obviously every pitcher wants to avoid Tommy John surgery, but the procedure itself does not have to result in long-term regression as it did only a decade ago.
Tommy John surgery is actually becoming a fairly routine procedure for pitchers both at the big league and minor league levels.
The biggest variables are how his body will react to the surgery and if he can build a routine that will avoid further degradation of the elbow. Mechanics play a role in his recovery as well. Nationals coaches and scouts need to examine what could have contributed to the tear and correct it.
Say Strasburg has the Tommy John surgery over the weekend; that will give him roughly eight to 10 months of recovery if everything goes well and there is no major setback.
But it serves the Nationals best to be prudent. Chances are Strasburg misses most, if not all of the 2011 season with the chance to play to winter ball somewhere after the season.
It's an unfortunate turn of events for MLB and fans. However, pitchers who have undergone Tommy John surgery have the opportunity to come back just as strong as before, and in some cases stronger. Hopefully that is the road for Strasburg and not a worst-case scenario (Mark Prior?).