Josh Lewsey will miss his first England game since the 2003 World Cup after being ruled out of Saturday's clash with Italy.
The Wasps full-back, an ever-present under head coach Andy Robinson, damaged his right shoulder in the first minute of England's 47-13 victory over Wales at Twickenham.
Lewsey soldiered on for 20 minutes but finally conceded defeat when he could no longer lift his arm. The England camp were relieved that a scan on his ACL joint - which connects the collar bone to the shoulder - showed no evidence of structural damage.
Leicester winger Tom Varndell, fresh from scoring four tries for England A last weekend, has been drafted into the 31-man squad as Lewsey's replacement. Bristol scrum-half Shaun Perry has also been called up, in place of Gloucester's Peter Richards who also has a shoulder injury.
Winger Mark Cueto suffered bruising to his lower back, but is available to Robinson, who names his side to play Italy tomorrow afternoon. Tom Voyce, Lewsey's Wasps colleague, impressed Robinson with a try-scoring performance off the bench on Saturday and could now make his first Six Nations start for England.
But England are unlikely to make many other changes for the trip to Rome, where they face an Italian side who gave Ireland quite a scare at Lansdowne Road.
