Ross placed on IL with partial tear of elbow ligament

A summer of misery for the Nationals took another turn for the worse in the last 24 hours when Joe Ross reported forearm tightness following a bullpen throwing session and a subsequent MRI revealed a partial tear of his elbow ligament.

The club hasn't finalized a plan yet for Ross, but he will be examined by Keith Meister, the Dallas-area orthopedist who performed Tommy John surgery on him four years ago, and a second major elbow procedure is possible. If that does prove to be the course of action, Ross would miss the majority (if not all) of the 2022 season.

"I talked to Joe this morning for quite a while. He's down. We're all down," manager Davey Martinez said during a somber Zoom session with reporters prior to today's series finale against the Braves. "But we hope the best comes out of this. I don't want to make any assumptions until he goes and sees Dr. Meister and we get a report from him as well."

Ross, who gave up four runs in five innings while throwing 82 pitches Wednesday in New York, took the bullpen mound at Nationals Park on Saturday for his regular between-starts throwing session. Afterward, he reported forearm tightness to the team's medical staff.

An initial exam by club orthopedist Robert Najarian led to a diagnosis of a flexor pronator strain, and given Ross' injury history, the Nats sent him for an MRI during Saturday night's game. After the game, Martinez learned the MRI showed a partial tear of the ulnar collateral ligament.

UCL tears often require Tommy John surgery to replace the damaged ligament, though in some cases a pitcher can rest, receive treatment and proceed without going under the knife. The success rate for pitchers returning from Tommy John surgery is quite high, but the rate drops precipitously for those who need to have the surgery a second time.

"It's obviously tough because of what he went through in the past," Martinez said. "The biggest thing for him to do now, and for all of us to do, is to stay positive for him. We're just going to have to wait for what Dr. Meister diagnoses him with. We're keeping our fingers crossed, and then we're go from there."

Even in a best-case scenario, the Nationals are going to be cautious with Ross. They already planned to monitor his workload this season after he opted out of the pandemic-shortened 2020 season and they already showed caution with him last month when he reported forearm soreness and they put him on the IL for three weeks.

"There was a fine line between (shutting him down longer) because, one, he sat out last year. Two, he wants to compete," Martinez said. "By the conversations that we had with Joe, and we always have with Joe, he felt good. He had little issues where we shut him down right away, and he came back and he said he felt great. Now we're at the point now where we did everything we can to keep him healthy. But for me, you can't ever predict injuries; they just happen."

If Tommy John surgery is needed, Ross would need at least 12 months of rehab, which means he wouldn't be likely to return until late in the 2022 season at the earliest.

"But I told him: You're still a big part of this team," Martinez said. "We'll get through this, but you've got to stay positive, got to keep your head up."

Ross was having a wildly erratic season that at times saw him dominate while at other times get hit hard by opponents. In six of his starts, he pitched at least five innings and did not allow an earned run, a total surpassed throughout the majors by only Zack Wheeler, Jacob deGrom and Walker Buehler. But he also gave up five or more runs in five starts, and that left his season ERA at a pedestrian 4.17.

Still, in their attempt to rebuild a roster only two years after winning a championship, the Nationals were counting on Ross to be part of their revamped rotation. Now he may join Stephen Strasburg as huge question marks moving forward due to injury.

For the immediate future, the Nats can get through the week without making any additions to their rotation, thanks to scheduled off-days Monday and Thursday. Erick Fedde will start Tuesday against the Blue Jays, with Josiah Gray on Wednesday. By early next week, though, they'll need to find a new fifth starter, with recently called-up left-hander Sean Nolin the likeliest choice.