Sunderland have been dealt a further blow ahead of Saturday's game against West Bromwich Albion with David Moyes revealing that Lee Cattermole, Steven Pienaar and Victor Anichebe will miss out.
Cattermole, 28, missed the start of the campaign following surgery on a double hernia, and he will once again be on the sidelines when the Black Cats are in action against the Baggies due to neuro pain from his spine.
Vito Mannone (elbow), Seb Larsson (knee) and Fabio Borini (groin) remain sidelined with Adnan Januzaj (ankle) - ruled out of action earlier this week – joined by Pienaar (hamstring) and Anichebe (groin) in the treatment room.
And speaking at his pre-match press conference, Moyes admitted the loss of a key quartet is a bitter blow.
"We have a few injuries this week; Steven Pienaar pulled up with a hamstring injury last weekend - I don't think it's too severe but it'll be enough to miss the game – with Adnan and Lee Cattermole out as well.
"Lee has neuro pain pain coming from his spine and down his leg, so we expect him to get an epidural today [Friday] or certainly over the weekend."
He continued: "Januzaj's injury is a blow because he'd done well in a couple of games and looked as if he was finding a bit of form.
"He's a really creative player for us and we need him.”
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