Jofra Archer, England's strike bowler, has been ruled out of the second Test in Chennai after receiving an injection in his right elbow.
Archer was instrumental in England's 227-run victory in last week's first Test, claiming three wickets in the match including both of India's openers in a fiery new-ball spell in the first innings.
But he was unable to train on Thursday after reporting pain in his right elbow and has subsequently undergone a painkilling injection.
The England camp do not believe the issue is serious and hope Archer will have recovered to play in the third Test, in Ahmedabad, which starts on February 24.
Archer suffered a stress fracture in the same elbow around a year ago, though a statement from the England camp insisted "the issue is not related to any previous injury".
The statement continued: "It is hoped the treatment will allow the condition to settle down quickly, allowing the player to return to action in time for the third Test in Ahmedabad."
However, the injury is a major loss to England as they seek to build on the efforts in the first Test. As a bowler capable of generating 90mph pace, Archer had the means to transcend the conditions while the surface was still true in the first half of the game.
England were already set to make at least one change with Ben Foakes replacing Jos Buttler, who has returned to the UK for a rest. With Mark Wood also at home - though expected back in India with Jonny Bairstow on Friday - the closest like-for-like replacement England have for Archer is Olly Stone.
Stone made a decent impression in his only Test to date, against Ireland at Lord's in 2019. But he has managed only one first-class game since due to injury and England might be reluctant to bring him in for such a high-profile game on a surface which is expected to be slow and offer turn from an early stage.
England have already indicated that Stuart Broad will be recalled in Archer's place, having originally been earmarked to rotate into James Anderson's senior-bowler role, but there is now an increased chance that both could play. Chris Woakes, who might also strengthen the batting, is another option.
England also have a choice to make about their spin bowling. While Dom Bess claimed four first-innings wickets, he bowled 19 full tosses across the match and looked oddly out of sorts by the end of it. Moeen Ali, who has endured a miserable trip so far, could replace him. Moeen spent the first two weeks of the Sri Lanka tour in isolation after being diagnosed with Covid-19.
Writing in his column in the Daily Mail, Archer reflected on his pride at playing a role in a famous win in the first Test, but revealed that his celebrations had already been muted by a stomach complaint, before the extent of his elbow problem was revealed.
"I'm not a big beer drinker and I would normally have a spirit to celebrate," Archer wrote. "But I didn't partake because I wasn't feeling well. I had a serious tummy ache, which might have been food poisoning, so I just slept. Stuart Broad didn't feel too good, either.
"Nevertheless, because of the quality of the opposition, our win felt like a serious achievement.
"Winning by 227 runs against that India team in their own conditions makes it that bit more special. It needs to be put into perspective, of course. It's only the first game and it would be dangerous to get giddy. We mustn't do that."
Archer also acknowledged that his experience of playing in the IPL had helped him to come to terms with the conditions in the first Test, but added that the extent of the pitch deterioration in the course of the game had taken him aback.
"On the fifth day it was probably the worst surface I've seen -- its orange colour, bits missing, rough patches for the bowlers to aim at," Archer wrote.
"When we walked out in search of nine wickets on the fifth day, I was very hopeful we would complete the job -- although these India players have big reputations and are at home, so should be able to cope with conditions better than anyone.
"So, I didn't expect us to skittle them. Equally, I didn't expect it to finish not long after afternoon drinks.
"I've played in tournaments around the world, and had success, but winning a Test is one of those indescribable feelings, especially against a really good team. Nothing compares."