Mark Wood was all but ruled out of bowling in the remainder of England 's first innings with the ball after sending down just five overs on day three.
In a worrying development for England's callow pace attack, their fastest bowler spent most of the day receiving treatment for a sore elbow that flared up overnight in the Caribbean.
Wood complained of soreness when he arrived at the ground and was being treated by England medics when play began, causing him to join his teammates a little later on the field with strapping on his right arm.
The 32-year-old sent down four overs with the old ball, finishing the spell conceding nine runs from the final over as Nkrumah Bonner cut and pulled a pair of boundaries.
His pace was a touch down from an average speed of 89 mph on day two, and clocked an average of 85 mph as he tried to give the Windies batsmen the hurry up.
With the second new ball arriving on the stroke of 80 overs Joe Root called on his quick man for another burst 40 minutes later, but after just one over he had to leave the field for more treatment and didn't reappear.
It meant that all rounder Ben Stokes was called on to bowl even more overs than was planned as he continues his return to full fitness after a side injury.
He was up to 20 overs for the innings straight after tea, and had showed his value early on by snaring the prized scalp of Jason Holder for 45.
The terms fast bowler and elbow injury are enough to send shudders down the spine of any England supporter with Jofra Archer spending the best part of two years battling with the problem area.
It is unclear the precise nature of Wood's injury but with so much resting on his shoulders as England's fastest strike bowler, the hope is that the soreness is just a reaction to bowling at full tilt again and will settle down.
Wood has never had a winter as busy as this one, playing in his fifth Test match having missed just the one Ashes Test in Adelaide during the Ashes.
His previous best was two and the extra workload may well be taking its toll on a body that has been notoriously difficult to get fit and firing.
The Durham man has persevered though and was enjoying his most consistent period in his career, thanks to a lengthened and more rhythmic run up that has helped him stay relatively fit.
On a slow and generally unresponsive pitch, Wood's efforts have been largely nullified, but with a harder and faster surface expected in Barbados for the second Test starting on Wednesday, the loss of another proven Test class bowler, albeit not self inflicted, would be a huge blow.
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