Washington Nationals starter Stephen Strasburg left Wednesday night’s game abruptly in the top of the third inning after throwing a slider and grimacing. He felt a “pinch” in the back of his elbow, according to Nationals manager Dusty Baker. Strasburg is scheduled to have an MRI on Thursday. He was not in the Nationals‘ clubhouse following their 5-4, 11-inning win against the Atlanta Braves.

Strasburg was making his first start since being placed on the 15-day disabled list Aug. 22, retroactive to Aug. 21, because of right elbow soreness. The Nationals stressed at the time that placing Strasburg on the disabled list was a precautionary move. General manager Mike Rizzo said then that if the first-place team was in a tight pennant race and it was Strasburg’s turn to pitch, he would have been able to.

“I think if we were later in the season and we had to have him pitch, he could pitch for us, and he would pitch for us,” Rizzo said at the time.

Wednesday, Strasburg started with two efficient innings, hitting 96 mph on the radar gun with his second pitch. But, after he threw a slider with one out in the third inning, Strasburg flexed his arm and pounded his fist into his mitt twice. Nationals trainer Paul Lessard and pitching coach Mike Maddux went to the mound to talk to Strasburg. After a brief discussion — and before manager Dusty Baker went to the mound — Strasburg began to walk off. He walked into the dugout with his glove covering the bottom half of his face.

“I’m hoping he’s OK,” Baker said. “We’ll find out more [Thursday].”

Baker characterized Strasburg as both “frustrated” and “upset.”

Before the game, which started an hour late because of a rain delay, Baker had asked Strasburg is he was “psyched” and “ready” to pitch. Baker said Strasburg answered, “Yes,” to both. Baker said after the game that Strasburg did everything that was asked of him in preparation for the start, then was cleared by the team’s medical staff.

“He wasn’t trying to be the hero,” Baker said. “He said that he felt fine. But, a lot of times you really don’t know until you get into action.”

Strasburg threw 42 pitches before leaving the game. He lasted 2 1/3 innings, allowed a run and struck out four.

The No. 1 overall pick in 2009, Strasburg was given a $175 million extension in May despite multiple disabled list visits in the past. This season, an upper back strain placed him on the disabled list. Last season, an ankle injury and a “knot” in his upper back caused him to miss time. Most notably, Strasburg had his right UCL repaired via Tommy John surgery in 2010. In six-plus seasons, Strasburg has made 23 starts or fewer four times.

Rizzo said at the time of this season’s elbow injury that the Nationals did not have an MRI exam done on Strasburg’s elbow because they had one from May, when he underwent a physical before receiving the extension. It’s unclear if he had one after Rizzo spoke to reporters and before Strasburg returned.

When Strasburg was placed on the disabled list because of the elbow soreness in August, he explained that his elbow had bothered him since the All-Star break. He was losing range of motion after each outing.

“I was losing flexibility and never getting it back,” Strasburg said at the time.

Strasburg has long relied on lifting weights as part of his workout regimen. Following the stiffness he experienced in his arm, Strasburg decided that flexibility would be a new focus.

Strasburg also noted that his arm and body will act differently after having Tommy John surgery as a 21 year old.

“I had it when I was young, so I think my body was in a little bit of a different spot,” Strasburg, now 28, said in August. “I am getting older.”

When Strasburg and fellow starting pitcher Joe Ross were on the disabled list the last three weeks, the Nationals tried a trio of solutions to replace them. Prospects Lucas Giolito, Reynaldo Lopez and A.J. Cole all received chances to pitch. The results were mediocre. Giolito, the organization’s top prospect, entered Thursday night’s game in the fourth inning with a 5.62 ERA. Lopez has a 5.52 ERA. Cole compiled a 3.86 ERA in three starts.

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