Jofra Archer has been ruled out of England's two-Test series against New Zealand, starting at Lord's on June 2, and may face surgery on his troublesome right elbow after failing to come through this week's return to first-class action.
Archer, who was withdrawn from this year's IPL prior to its postponement earlier this month, had undergone a series of cortisone injections to enable him to get through the T20I leg of England's white-ball tour of India in March.
He also underwent an operation on the middle finger of his right hand while receiving further treatment on his elbow, to remove a splinter of glass following a bizarre incident involving a fish-tank. He showed no ill effects following that treatment and has been playing without protection on the affected digit.
After a low-key return to action for Sussex's second XI against Surrey two weeks ago, Archer appeared to be returning to his best when he picked up two wickets, including his England Test team-mate Zak Crawley, in a hostile new-ball burst on his return to the County Championship against Kent at Hove this week.
However, he bowled just five overs in Kent's second innings, and none on the final two days of the match, a situation that appeared to have caused confusion for his Sussex captain Ben Brown on a rain-shortened third day, when he gestured for Archer to open the bowling but had to turn instead to his team-mate George Garton.
"It was a communication thing with Jofra on Saturday evening," Brown said at the conclusion of the match. "There is no issue. I asked him beforehand if he was going to have a bowl and he said yes in a warm-up capacity. But he was feeling too sore to bowl.
"The issue here is a sad one for Jofra. He's a champion cricketer, so talented and so gifted, but at the moment he cannot do what he wants to do, he cannot do his skill.
"I really feel for him. He's in a difficult situation, with that skill of bowling really fast being taken away from him if you like. This week has been very challenging for him. He was hopeful about how it would go, but he's felt pretty sore in this game."
An ECB statement subsequently confirmed that Archer "was suffering from pain in his right elbow when bowling and was unable to bowl in the final two days of the match.
"The England and Sussex medical teams will now seek guidance," the statement continued, "and Archer will see a medical consultant later this week to determine the next course of action on the management of his elbow."
Archer first suffered problems with his right elbow during the tour of South Africa in January 2020, when a stress fracture was detected that ruled him out of the final three Tests of the series, as well as the subsequent one-day campaign.
The option of surgery may be the preferred course of action for Archer and for England - not to mention his IPL franchise, Rajasthan Royals - given his importance to the team's plans across formats in the back-end of the year.
As the MVP in the last IPL in November 2020, and following a series of hostile displays in the 3-2 series loss in India, Archer's value to England's T20I attack is paramount, especially given that the team will go into the T20 World Cup in October and November as one of the favourites, and seeking to become the first team to hold the 50-over and 20-over titles concurrently.
Then there is the Ashes campaign in Australia hot on that tournament's heels - a tour that England's Test captain, Joe Root, admitted this week was the "pinnacle" of their plans for 2021, notwithstanding a five-match home series against India before that.
In the meantime, England have already indicated that they will be giving opportunities to fringe members of their Test squad during the New Zealand series - not least among them, Archer's fellow Sussex seamer Ollie Robinson, who has been a fixture in the biosecure environment without yet being given a Test debut.
Mark Wood and Olly Stone, who like Archer can bowl at speeds in excess of 90mph, are expected to be included in the squad, although the contingent of players who have recently returned from the IPL - including Jos Buttler, Jonny Bairstow, Sam Curran and Moeen Ali - are expected to be rested, due to the time they have already spent in bio-secure environments.
Ben Stokes is already ruled out of the series after sustaining a broken finger during his stint with Rajasthan Royals at the IPL.
Andrew Miller is UK editor of ESPNcricinfo. @miller_cricket