Italy's Daniele De Rossi has a leg injury and is highly unlikely to play in the World Cup Group D showdown against Uruguay on Tuesday, the Azzurri's team doctor said on Saturday.
The 30-year-old midfielder played the full 90 minutes in both of Italy's games in the tournament, a 2-1 victory over England and a 1-0 loss to Costa Rica.
"He has a muscle problem in his leg," Enrico Castellacci told a news conference on Saturday.
"It is highly unlikely that he will be able to play on Tuesday. "If I was being positive I would say that it is possible the injury to the muscle would improve but it is highly improbable he will play."
De Rossi is likely to be replaced by Brazilian-born Thiago Motta alongside the influential Andrea Pirlo in midfield. A point against Uruguay would send the Italians through to the knockout stage with Costa Rica.
Castellacci said De Rossi would probably need a week to 10 days to recover completely, making him also a doubt for Italy's potential last-16 clash, should they get the result they need on Tuesday.
Central defender Andrea Barzagli, who was an injury doubt before the England and Costa Rica matches because of a long-term tendonitis problem, is recuperating well and will be up to playing a third match in 10 days, Castellacci said.
There was also good news about fullback Mattia De Sciglio, who missed the first two games of the tournament with a calf strain but is back in training and will be available. There had been a couple of minor knocks for other members of the squad in the Costa Rica match, Castellacci said, but none that would prevent anybody from playing.
"(Midfielder) Claudio Marchisio has a little problem with his knee but it's the kind of thing that will clear up in a couple of days," he said.
The squad, who arrived in Natal on Friday, were given a rousing reception by several thousand fans at the home of the local team, ABC.
Tuesday's match is again an early kickoff with the Italians taking on Uruguay in the full heat of the day as they did in the match against Costa Rica.
Castellacci said the heat had caused the Italians problems in Recife but at least the Uruguayans would be equally unaccustomed to it. "For the Costa Ricans, the temperature was routine but for us it was tough," he said. "The players felt it. Against Uruguay, it will impact both sides in the same way."
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