Jason Robinson has been ruled out of England's pre-RBS 6 Nations training camp and is a doubt for the opening game against Scotland on February 3.
The Sale captain reported for duty at Twickenham but was sent home along with fellow wingers Mark Cueto and Paul Sackey after being assessed by the England medical team.
Cueto is recovering from a calf problem and Sackey has suffered a knee injury which is likely to keep him out of action for up to a month.
But, according to officials at Sale, Robinson returned north in poor condition after a punishing schedule of five games in 20 days over the Christmas and new year period.
Robinson missed Sale's European Cup defeat to the Ospreys at the weekend with a neck injury and will sit out this Saturday's Premiership clash with Gloucester.
Sale coach Kingsley Jones explained they had wanted to rest Robinson sooner but had their hands tied by a remarkable injury toll, which extended to 13 when prop Lionel Faure was ruled out for eight weeks with medial ligament damage.
The RFU are reportedly looking to reach an agreement with Premier Rugby, the umbrella body for the Premiership clubs, on centrally managing the England players.
England coach Brian Ashton was also without lock Louis Deacon (knee), prop Phil Vickery (ankle) and flanker Magnus Lund (calf) after bruising European Cup encounters at the weekend.
The trio are all expected to join in training on Wednesday, though Julian White is a doubt after suffering a knee problem.
The wing issue is looming as a major problem for Ashton just 10 days before England tackle Scotland, his first game in charge.
Robinson, who has come out of international retirement in to help England's World Cup defence, could head into the Test after two weekends off.
Jones said: "For him (Jason) to go straight in against Scotland after not playing for two weeks is a big ask but that will be England's call."
Of the available resources in the current squad, Iain Balshaw and Josh Lewsey can both play on the wing.
Mathew Tait is also a potential back three option. He filled in as a winger on the summer tour of Australia and was, intriguingly, employed as a full-back for Newcastle last weekend.
Otherwise, Ashton could call on Ben Cohen and James Simpson-Daniel who were omitted from the main party and included in the England Saxons squad.
For Jacques Brunel and Italy the goal for every RBS 6 Nations is to win games, but, in this his fourth and final Championship in charge, the head coach is just as worried about performances as results.
Sam Burgess' first outing wearing the Red Rose was relatively quiet but after helping England Saxons to a 18-9 win over the Irish Wolfhounds head coach Jon Callard has backed the rugby-league convert to be a hit in union.