Tom Rees is set to miss England's opening two matches of the Six Nations after damaging knee ligaments in London Wasps' 24-18 win over Harlequins yesterday.

The flanker appeared as a replacement in the Guinness Premiership match after Wasps opted to ease him back into action following a serious nose injury and was only on the pitch for three minutes before sustaining medial ligament damage.

A scan will today confirm the injury and Wasps officials expect the England No7 to be sidelined for up to eight weeks, ruling him out of the Six Nations matches at home to Italy on 7 February and away to Wales the following week.

Rees's absence could see London Irish flanker Steffon Armitage added to the England Elite Player squad for the first time when team manager Martin Johnson announces his 32 players on 15 January.

There is likely to be even more bad news for Johnson today, with Wasps lock Tom Palmer seeing a specialist who is almost certain to confirm he needs surgery to solve a recurring shoulder injury. There is also a doubt over Simon Shaw, his fellow Wasps and England lock, who needed an injection in his left elbow to play against Quins.

Shaw is also visiting a consultant today to asses the problem which could require key hole surgery to flush out pieces of bone causing the pain. Also on the Wasps injured list is England flanker Joe Worsley (broken hand), Josh Lewsey (hamstring) and captain Rafael Ibanez (head).

Wasps are struggling to cope with these set backs and found themselves without wing Paul Sackey against Quins after England medical staff ruled his ankle injury needed rest.

This decision has angered Ian McGeechan, the Wasps director of rugby, who believes the incident highlights problems with an agreement that is supposed to ensure player welfare is the main priority. McGeechan will speak to Johnson about the Sackey decision and said: "The England physio decided Sackey wasn't fit to play Saturday morning. We will be following up the process. I wasn't happy with it."

Having lost Sackey, McGeechan was annoyed to learn that under the England elite players squad (EPS) agreement, which forced the club to rest their England men for at least one game, Harlequins have been able to play Nick Easter and Ugo Monye throughout December.

Easter and Monye played all four Tests in the autumn but do not officially count as EPS members because they were injury replacements who were added to the original 32-strong squad.

"If it is such a big thing let's have an even playing field, because we are getting screwed off the field and screwed by what we can put on it," he said.

Wasps were 21-3 up at half time thanks to Danny Cipriani's boot, Chris Bishay's well-taken try and a penalty try. But Cipriani contributed to Quins second-half fight-back by being charged down - yet again - and this led to a penalty try.

Shaun Edwards, the Wasps head coach, admitted Ciprani's continuing problem with charged down kicks is big concern, saying: "They have been a nightmare for us this season. He is kicking too slowly and not high enough."

Harlequins director of rugby Dean Richards, who praised Danny Care's brilliant individual try, was unhappy with referee Sean Davey and said: "There were 10 free-kicks or penalties in the scrum area and you have to question whether we - Wasps and Harlequins - are as bad as people make us out to be or whether somebody else got it wrong on the day."