Merouane Zemmama has added to Middlesbrough's midfield headache after it was confirmed he needs a hernia operation.
The Morocco international will go under the knife this week and Boro boss Tony Mowbray could have done without his absence.
With Nicky Bailey already sidelined, both Kevin Thomson and Julio Arca are now due to serve suspensions after the pair were sent off in the defeat to Coventry at the weekend.
"Merouane will have a double hernia operation," Mowbray confirmed, with the Boro boss now facing a selection dilemma ahead of Sunday's FA Cup derby clash with Sunderland.
"We've had two midfield players sent off, we've got Nicky Bailey injured, we're pretty short in that area of the pitch.
"We'll have to have a look around and decide what the best way for us to play in the game on Sunday is going to be."