Top pick might require Tommy John surgery

An elbow injury gave the Nationals the chance to select one of the country's most electric young arms in June's Major League Baseball draft. But the front office also knew Lucas Giolito's health was tenuous.

The organization received bad news Monday when Giolito, diagnosed with a strained right elbow ligament in February, experienced more elbow pain after an outing with the Gulf Coast League Nationals on Aug. 14. That initial injury caused him to drop all the way to Washington at No. 16 in the draft, and the Nats were thrilled.

Giolito already has met with team doctor Wiemi Douoguih and soon will head back to his hometown of Los Angeles for a second opinion from Dr. Lewis Yocum, the noted orthopedist who performed Nats pitcher Stephen Strasburg's Tommy John surgery in 2010.

Rizzo said Giolito had soreness in the elbow following his only GCL appearance and at the very least the injury, according to Douoguih, is the same one diagnosed before the draft.

"We knew when we drafted [Giolito] this was an issue," Rizzo said. "We were comfortable with the fact that worst-case scenario it was Tommy John surgery and we'll see if that's where we're headed. But going into this with our eyes wide open, we felt that this was a scenario and a possibility."

Rizzo said Giolito threw the ball pain free upon his return from the initial elbow strain. He continued a throwing program in July at the team's spring training headquarters in Viera, Fla., before joining the GCL Nats roster. Giolito only threw two innings in that league, allowing two hits and a run with one strikeout.

Giolito, 18, would miss between 12 and 18 months if Tommy John surgery is necessary. The right-hander was rated the top high-school pitching prospect before the draft by Baseball America and No. 9 overall. ESPN's Keith Law wrote in June that Giolito was "perhaps the only pitcher in this draft who has true No. 1 starter upside." That promise likely will be delayed now.

"[Giolito] wants to be healthy and get back on the mound pitching," Rizzo said. "So whatever road gets him to that end sooner, that's the one he's going to take."