Carlos Alcaraz has pulled out of next week’s Italian Open in Rome after suffering more discomfort in his forearm.

The Spaniard missed the opening two big European clay-court events in Monte-Carlo and Barcelona with the injury but returned for a tilt at a third successive title at the Madrid Open.

However, Alcaraz was beaten by Andrey Rublev in the quarter-finals and has now revealed his right arm remains a concern with less than a month to go until the start of the French Open.

Alcaraz wrote on social media: “I felt some pain after playing in Madrid, some discomfort in my arm. Today I did some tests and I have a muscle edema in my pronator teres, a consequence of my recent injury.

“Unfortunately I will not be able to play in Rome. I need to rest so I can recover and play 100 per cent pain free. I am very sorry, I will see you next year.”

Doubts also remain about the fitness of Australian Open champion Jannik Sinner and world number four Daniil Medvedev, who both pulled out mid-tournament in Madrid because of injuries.