On the positive side, most pitchers who have this surgery return as good as ever.
But this comes at a time when the last-place Nationals were building their 2011 season -- and beyond -- around the No. 1 overall pick in last June's First-Year Player Draft.
There was hype throughout Major League Baseball whenever Strasburg pitched. TV networks couldn't wait to get him on their broadcasts, beginning on June 8 when he struck out 14 Pittsburgh batters in his debut. He had become one of the biggest attractions in baseball, much bigger than his hype.
Because of him interest in the Nationals, which have been struggling for attention and fans in Washington, has increased tremendously. Add to that the outlook for the future in National League East and you can see what an immediate loss Strasburg is.
"It's a tough day for him and for all of us, for everyone who's a Nats fan," said team president Stan Kasten. "We saw Jordan Zimmermann come back last night. A year from today, Stephen will be joining him."
When the 22-year-old right-handed pitcher was on the mound there was a different atmosphere around the Nationals. He'd won five of eight starts with a 2.91 ERA and an uncanny 92 strikeouts. His fastball frequently hit 100 mph and his killer changeup in the low 90s. He could throw all four of his pitches for strikes, no matter the count.
I haven't seen many young pitchers, or players for that matter, with the presence he possessed in the clubhouse.
It's not uncommon for power pitchers to tear this ligament and require the reconstructive surgery named after left-hander Tommy John. But with Strasburg, I must reiterate, the injury is much more important to the Nationals than merely losing one of their top pitchers.
Premier pitchers such as Chris Carpenter -- he faced the Nats on Thursday night for St. Louis -- Billy Wagner, Josh Johnson, Tim Hudson and even Washington's Zimmermann have come back strong after the procedure. Zimmermann, another premier prospect expected to be No. 2 behind Strasburg, made his first start since the surgery Thursday night.
"I look at the bright side," said Mike Rizzo, Nationals general manager. "Tommy John surgery is a surgery that we've had great success at. The success rate for guys coming back from Tommy John and retaining their stuff is very good."
The lingering question throughout baseball is did the Nationals rush him to the Major Leagues?
They took exhausting precautions, including putting a pitch limit of 160 innings, including the Minor Leagues, on his 2010 season before shutting him down. He was at a total of 123 1/3.
But considering the San Diego State product who signed for a record $15.1 million was only 21 (he turned 22 on July 20) when he went to the mound amidst a sellout crowd that exciting June night against the Pirates, he undoubtedly put maximum effort on every pitch. He had to live up to his credentials.
There is enormous strain on a pitcher's arm. I firmly believe there is too much emphasis put on pitch-count in the Minor League and not in building up arm strength, but that's another story.
Strasburg was placed on the disabled list after right shoulder stiffness during his warmups in the dugout on July 28. He threw just eight pitches.
Saturday, against the Phillies, he was making his third start since returning from the DL. Facing outfielder Domonic Brown, he grimaced in pain after throwing a 1-1 pitch and shook his right arm. He immediately left the game. An arthrogram on Thursday revealed the tear.
"The player was developed and cared for in the correct way, and things like this happen," Rizzo said. "Pitchers break down, pitchers get hurt and we certainly are not second-guessing ourselves. Frustrated? Yes. But second-guessing ourselves? No."
Craig D. Morgan, a renowned orthopedic surgeon, who's performed numerous surgeries on premier athletes such as former pitcher Curt Schilling, ironically watched Strasburg pitch on Saturday.
"All elbow problems originate from the shoulder," Morgan told MLB.com Friday. "Strasburg was on the disabled list two weeks before Saturday with a shoulder problem. His delivery is very similar to Schilling's, very compact. He faces the catcher and square from the rubber when he gets the sign.
"I could see that his right shoulder was down compared to his right, which means he has muscle weakness. That's the No. 1 cause of the Tommy John ligament injuries. It's all preventable."
Morgan recently completed a seven-year study with W. Ben Kibler, Lexington, Ky., orthopedic surgeon, during which 300 cases of tennis players and baseball pitchers with medial elbow problems were examined.
"All 300 cases had scapular muscle weakness in the shoulder," he said. "That's why they end up tearing their elbow ligament. The problem's in the shoulder. When I watched Strasburg pitch I told my wife in the first inning ... I told my wife he would be on an operating table within a week. Was I wrong?"
Schilling, on ESPN earlier in the week after Strasburg went on the DL, discussed the same shoulder motion and also predicted Tommy John surgery for the young pitcher.
Morgan performed shoulder surgery on Schilling, who said at 32, he threw much harder than he did before the operation.
"And he has three World Series rings to show for it," said Morgan.
Before a final decision on Strasburg is made, he'll seek a second opinion from Dr. Lewis Yocum in Southern California.
Morgan, who has a long-standing working relationship with Yocum, favors the second opinion but feels the result will be the same.
Throughout his tenure with the Nationals, almost from the moment he was drafted, Strasburg has been a captivating story. His first game was spectacular. Fans couldn't wait to see him pitch.
Sadly, they now must wait for that to happen again.