England prop Andrew Sheridan has been ruled out of the Rugby World Cup with a shoulder injury, the Rugby Football Union have announced.
Sheridan will return home for treatment, subject to final approval from the tournament's medical director, and he will be replaced in England's 30-man squad.
England manager Martin Johnson is yet to decide on the identity of Sheridan's replacement.
Sheridan, who had just returned from reconstructive surgery on his right shoulder, injured the left one in England's opening World Cup win against Argentina.
The Sale loosehead prop has undergone two operations on that shoulder since dislocating it in October 2009.
Scans were sent back to the UK for the specialists who have operated on him in the past to determine the full extent of the problem.
England received confirmation that Sheridan's injury was significant enough for him to be sent home. Under tournament rules he then cannot return.
Johnson said: "It's really sad for Sheri. He has been unlucky with injuries and we wish him all the best for his recovery.
"We brought five props so we have options there and we can bring another player out but we will decide what to do about that in due course."
Northampton prop Paul Doran-Jones and Wasps' Tim Payne are the leading options to replace Sheridan having been included in England's initial 45-man training squad.