The world No. 5 suffered a one-sided loss in Thursday’s quarter-final match against Sinner, going out 6-1 6-4.

He struggled with his serve at times and later confirmed he was facing a new physical setback. “I, unfortunately, had pain on my shoulder, which I didn’t think I would have,” Medvedev said.

“It started yesterday during the match, but I thought it was nothing, and I still think, well, I still hope it’s nothing serious, I’ll have to do the checks tomorrow.”

The soreness didn’t just affect his serve as Medvedev explained his intensity also suffered.

He continued: “But it didn’t let me serve the way I wanted, and with Jannik serve is important, because he’s a great server now, it’s tough to break him, so you need to serve well, and without the serve it’s tough.

“Then when you have pain, the energy’s not the same. So, second set I tried to, like, pump my energy up, and it did help me a bit, but still, without the serve, it’s tough to beat Jannik, and that’s what happened.”

Medvedev has a busy schedule for the rest of October – next week’s Six Kings Slam and the ATP events in Vienna and Paris-Bercy. But his participation at all three could now be under threat.

“I have three tournaments where I’m signed up, let’s see if I play them, especially the problems with the shoulder, the problems, well, this, they started yesterday,” the former US Open champion explained.

Medvedev’s participation in the Saudi Arabia exhibition is especially in doubt as he is set to play his first match against Sinner next Wednesday. If he advances, he will have to face Novak Djokovic.

If Medvedev beats Djokovic, he will contest Saturday’s final. But if he loses he will still be back for a play-off match.

Organisers will be left scrambling if Medvedev does pull out before his first outing against Sinner in just five days’ time. The Russian has also already been included in the custom promotional materials.