On each occasion the midfielder’s determination, arguably far greater than his natural talent, has taken the 27-year-old to the very top of the game. Yet Tuesday, after officially announcing an extended absence from the game, Fletcher’s career is at more risk than ever. Suffering with an inflammatory bowel disease, ulcerative colitis, the Scot is to take an indefinite period on the sidelines; a huge blow both to player and club.

“Over the past year he has had several absence periods which we have attributed to a viral illness in order to respect his right to medical confidentiality,” read a United statement issued on Tuesday.

“Darren has, in fact, been suffering from ulcerative colitis (a chronic inflammatory bowel condition) for some time preceding this. Whilst he was able to maintain remission of symptoms for a considerable period this has proved more difficult recently and Darren’s continued desire to play and his loyalty to both his club and country has probably compromised the chances of optimising his own health and fitness. He has therefore accepted medical advice to take an extended break from the demands of training and playing in order to afford the best chance possible of achieving full remission once again.”

The Scottish captain first became ill last March, missing two months of the run-in with what was then described as a ‘mystery virus’. We now know it was nothing of the sort. But signs that Fletcher’s condition was serious were clear on the player’s return against Schalke 04 in the Champions League last May, with the Scot appearing gaunt having lost more than a stone in weight. Fletcher’s appearance had changed too, with the medication reportedly bloating the 58-cap international’s features. It is now clear the midfielder returned far too soon.

“The biggest thing was the weight loss,” admitted Fletcher in September.

“I lost close to a stone which for someone like me — I don’t have a stone to lose — was massive. That was the biggest thing, building my strength back up and putting my weight back on was a real struggle. I was stuck in bed for two weeks. But I had constant reassurance from the doctor that it was a bit of bad luck, a combination of different things that had a domino effect which set me back.

“I am a positive person so I expected to be back the next week, then it was a week later, and then I thought the next week. I just had to eat as much as I could to try to put it back on but even that is a struggle for me. I just ate as much as I could, protein shakes, meal replacements drinks.”

Fletcher’s absence, perhaps for the remainder of the current season, comes soon after captain Nemanja Vidić was ruled out for the campaign with injury. With Anderson out until the Spring and Tom Cleverley past New Year, Ferguson will now face up to life without a significant chunk of experience through his team’s spine. More to the point, the Scottish manager is facing a crisis over midfield numbers in the coming months. Even for a club of United’s size, the dual absences are a crushing blow.

Indeed, the question of whether United will now enter the transfer market in January – or at least entertain the thought – is a crucial one. After all, reports that the Glazer family has placed the club cheque book into lock-down are widespread and well sourced.

It is almost impossible, with the club’s senior central midfield options reduced to Michael Carrick and Darron Gibson, for Ferguson to now claim, as the Scot so often does these days, that he is happy with his resources. Throwing 37-year-old Ryan Giggs and Korean winger Park Ji-Sung into the mix hardly inspires confidence. Indeed, United’s options are so thin on the ground that Wayne Rooney and Phil Jones have been pushed into central midfield in recent weeks.

But United’s statement also raises plenty of questions. After all, the club has now admitted that not only did the medical team know of Fletcher’s condition well before Tuesday’s statement, it deliberately concealed it over the past nine months. The lack of veracity, even if Fletcher’s condition was obscured for reasons of privacy, will raise eyebrows. The cloak of secrecy only served to generate speculation.

Moreover, there is now an admission that deploying Fletcher has worsened the player’s condition. On the face of it, the club’s acknowledgement reflects poorly on the institution. After all, if United’s medical team knew of the player’s condition then it will also have advised – or been advised of – treatment options, presumably including the lengthy rest now prescribed. The question, coming so soon after Owen Hargreaves alleged mis-management of his own long-term problems, is a pertinent one.

Then there is the curious case of Fletcher’s contract, with the player signing a new four-year deal on much improved terms in May. It is perhaps the first known case of the normally parsimonious Glazer family extending a hand of financial generosity.

Further details will emerge in the fullness of time, but until then Ferguson is another man down, and a player’s career hangs in the balance.

United’s unanswered questions

• Why did Fletcher play on with a condition that, in hindsight, was so serious?
• Did Fletcher, as intimated in United’s statement, insist on playing in May and then August, or was any pressure brought to bear on the Scottish international?
• If the player insisted on playing, why did United’s medical team not intervene? Was he cleared to play?
• Why has United now broken typical club protocol, and Fletcher’s privacy, to announce the player’s true condition and absence?
• Why is an extended break now the prescriptive cure if was it not in May? Or August?
• Why was the player offered an extended contract when his long-term fitness was in doubt?

What is ulcerative colitis?

UC is an inflammatory bowel disease (IBD), which affects the large intestine. The sufferer usually displays constant diarrhea mixed with blood, although the condition is intermittent, with periods of exacerbated symptoms, and periods of remission. From the NHS:

The colon, also known as the large intestine, absorbs nutrients from undigested food and passes out waste products through the rectum and anus in stools (faeces). Ulcerative colitis causes the colon to become inflamed (swollen) and in severe cases, ulcers (painful sores) may form on the lining of the colon. These ulcers can bleed and produce mucus and pus. Symptoms of ulcerative colitis can range from mild to severe, with the condition being very unpredictable.

Symptoms can flare up and then disappear (go into remission) for months or even years. At its most severe, the entire colon can become inflamed (known as pancolitis). This form of ulcerative colitis is particularly challenging to treat. The causes for the condition are unknown, though research suggests that both environmental and genetic factors are involved.

Ulcerative colitis is an uncommon condition. It is estimated that there are ten new cases a year out of every 100,000 people. There are currently 100,000 people in England with ulcerative colitis. The condition normally appears between the ages of 15 and 30. The condition is more common in white people of European descent, especially those descended from Ashkenazi Jewish communities (Jews who lived in Eastern Europe and Russia) and black people. The condition is much rarer in people of Asian background. The reasons for this are unclear.

The outlook for most people with ulcerative colitis is usually quite good. Symptoms are often mild to moderate and can usually be controlled using medication. However, an estimated one in five people with ulcerative colitis have severe symptoms that often respond less well to medication. In these cases, it may be necessary to surgically remove the colon.

It was hard on the Scot, sent off during United’s semi-final second leg with Arsenal when the game and tie was already won. Moreover, in committing a ‘professional foul’ Scotland captain Fletcher got the merest toe on the ball, resulting in an unjustified red card, according to many pundits.

Once again 26-year-old Fletcher is in danger of missing a European final having been laid-low with a mysterious virus over the past two months. The illness, which has sidelined Fletcher for the best part of United’s run-in, left the player with considerable weight loss.

Yet, having played some reserve football and a brief appearance in the comfortable win over Schalke last week, Fletcher may take part in this year’s final. He is likely to make another appearance against Blackburn Rovers on Saturday and then – results permitting – will start against Blackpool on the final day of the domestic season.

“Darren has put the weight back on and is back in training, but he has a bit to do yet,” Ferguson confirmed.

“But, as far as the final is concerned, there is almost three weeks to achieve that. If he does reach the target, it will be a big boost to us as we all know he is big-game player. The 20 minutes he got against Schalke last week was certainly a step forward. His training, in terms of sharpness for such an important game, will be stepped up now.

“We’ve also got Blackburn Rovers away, Blackpoool at home, and even Gary Neville’s testimonial game so there’s opportunity for game time that will help him reach his target.”

But the question of Fletcher’s participation in European competition is certainly more nuanced than the midfielder’s fitness. Ferguson has a tactical conundrum to answer, especially with Michael Carrick and Ryan Giggs – aided by Wayne Rooney – in such good form during the past six week’s. Indeed, with time on the ball coming at a premium against Barcelona, United’s manager may not benefit from losing the Giggs-Carrick possession axis.

The alternative for Ferguson is to alter the tactical plan that worked so well against Chelsea in recent weeks, with Fletcher augmenting midfield and Rooney ploughing a lone furrow up-front. The change would add more steel to United’s midfield but disrupt Rooney’s renaissance at ‘number 10′ and force in-form Javier Hernández back to the bench. It might be a losing hand too, with United then betting on shutting out the Catalans’ extraordinary attacking threat while catching the opposition on the break.

However, defender Rio Ferdinand has backed the Scot’s return, claiming that Fletcher’s energy will add much to the United cause. It’s a fair point, with Fletcher arguably the only dynamic central midfielder in the United squad capable of effectively playing a more destructive role. Certainly, the horrors of Anderson’s performance against the Spaniards in 2009 will not easily be forgotten.

“Darren can run ridiculous amounts during games,” said Ferdinand.

“Park Ji-sung is the only person who could rival him running-wise. That says a lot. He covers a lot of ground, gets at people and can score important goals. He gets the crowd going and is an integral member of the squad. It will be great to have him back.”

Alternatively, Ferguson may opt to meet fire with fire by sending out an attacking United side to take on the newly re-crowned Spanish champions, consigning the fit Scot, at best, to the bench. The gambler’s instinct may just tip Ferguson to hold Fletcher back and retain a formula that has proven successful against domestic and European opponents recently.

In the meantime United should wrap up the Premier League with ease against a dispirited Blackburn side, which should be safe from relegation but has shown no real form under manager Steve Keen. The game may afford Fletcher 45 minutes this weekend, the full 90 against Blackpool at home and Neville’s testimonial four days before the Wembley final.

On Ferdinand’s part, the former England has promised a better performance from United in the Champions League final than last time out. It couldn’t get much worse.

“I have never watched 2009 again,” the Scot told ManUtd.com.

“But matches like that are hard to forget as it is clear in your head. If you want to sit and think about games like that they come up quite easily. It is like bringing something up on the internet. I have not watched it but I have re-run it in my head a few times. We never played. We never got on the ball. We weren’t Manchester United that day. This time we will give a better account of ourselves.

“On the way back we were sitting there thinking if only we had gone out and played and been the real Manchester United, it would have been different. They always say you don’t want to come off the pitch with any regrets. There were regrets that night.”

For Fletcher, fitness ought not to be a regret two years down the line.

“They are the team with the pressure because they are the team that’s leading the league,” Fletcher told Sky Sports News.

“All the pressure is on them and we just have to take care of ourselves. I think they have been in a position where they felt they could have pulled away and been in a real strong position, but they’re not, so from that point of view all of the pressure is on them.”

Fletcher denies the United team ever believed the title was lost to Chelsea, even after the disappointing scoreless draw with Blackburn a fortnight ago. And the Scot says that beating City last added extra pressure on Chelsea in the title race

“We never thought it was gone because there is still all to play for and anything can happen. It was a disappointing time after the Blackburn game, it really looked an uphill struggle from there, but it just shows you how in one weekend things can change.

“I think by winning [against City] it put a little bit of pressure on them again and gave Tottenham something to play for, and they did us a favour.”

Fletcher, who has scored four goals in 38 appearances for Ferguson’s side this season, believes Chelsea will drop points in games against Liverpool, Stoke City or Wigan Athletic in the run-in.

“It’s not insurmountable,” Fletcher told United mouthpiece ManUtd.com.

“Although we’re disappointed to have lost two late goals, 2-1 isn’t the worst result in the world. We now know what we have to do at home.

“We certainly respected Bayern before this match and we’ve still got great respect for them. They’re a very good side. You don’t play any bad sides in the quarter-finals of the Champions League.

“We’ve learned a lot about Bayern and about ourselves tonight and we’ll take all that into the match at Old Trafford next Wednesday.

“The Bayern midfielders pressed the ball quite quickly and got numbers behind the ball. It was difficult in there, but you expect that when you go away from home in Europe.

“We knew Bayern would have a lot of possession and we’ll be looking to do the same next week. We’re confident against anyone at Old Trafford.

“We know what to expect from Bayern Munich and we’ll be ready for their challenge.”

United must score at least once at Old Trafford and probably without Wayne Rooney, who hobbled away from the Allianz Arena on crutches wearing a protective cast round a badly twisted ankle. The 34-goal striker will have an MRI scan today to determine the extend of the injury.

“It would be very dangerous to think this is a poor Liverpool side coming to Old Trafford because they will be anything but,” the Scotland captain told the Manchester Evening News.

“It would be a huge mistake to think that Liverpool aren’t a threat. They maybe haven’t had the season we expected after the one they had last year but they are still a dangerous side.

“They are still the same team they were last year in the main. We know what they are capable of because they pushed us all the way and dished out that defeat here and the one at Anfield this season. They are still fresh in our memories.

“They still have a lot to play for because they are battling for fourth spot. On their day they are capable of beating anyone.

“We have to learn the lessons from last year’s game. The warnings are there. If you are not 100 per cent focused and you make mistakes then Liverpool will punish you.

“After last season everyone thought they would kick-on this year and would be right up there again. A lot of people tipped them to win the league. It hasn’t turned out that way for whatever reason.

“It is a real surprise to me they haven’t been up with us. But they’ll still be fired up to win at Old Trafford again.

“Last March’s defeat was difficult to swallow at the time. We were in the middle of the run-in and to lose against Liverpool, who were challenging us and especially at home, was tough.

“It is not about revenge. It is simply about the match and the title run-in.”

Fletcher has become United’s preeminent defensive midfielder this season with 32 appearances and four goals. Liverpool beat Portsmouth 4-1 at Anfield on Monday to reignite the Dippers’ belief that Rafa Benitez’ side can make fourth place this season.

But the effort put into their respective careers has seen each transformed from flops to favourites. So much so that Patty, Fletch and Sheasy can lead United to glory, confident in their status as fans’ favourites.

Patrice Latyr Evra, born 15th of May 1981, started his football career at a small French club, CO Les Ulis. At 16, accepted into the academy, the Dakar-born defender joined Paris Saint-Germain before moving to Italian club Marsala for his first professional contract. After a successful start to his career, including time at Monza in Serie B and then Nice, Evra signed for AS Monaco, following a switch from left-wing to left-back.

Four years later and Evra signed for United, with Liverpool, Arsenal and Inter Milan reportedly interested. It was the start of Evra’s rise to the pinacle of world football.

Evra’s journey wasn’t smooth sailing though. Substituted at half-time on début in a 3-1 defeat to Manchester City, many felt incumbent full-back Gabriel Heinze had little concern in keeping Evra at bay.

Nevertheless, the Frenchman pushed through his difficulties and soon became an important part of the team. He scored his first Premier League goal against Everton in 2006. By 2008, Evra was an essential part of United’s defence.

Over the years Evra has grown on United fans due to his unwavering loyalty to the club and his effusive personality – Evra one part of a comedy trio with Ji-Sung Park and Carlos Tevez. Evra’s altercation with Chelsea ground staff, together with outstanding performances on the pitch, probably didn’t hurt either.

While fans could never accuse Evra of being ‘Fergie’s Son’ that was the charge laid at Fletcher’s door early in his career. Presumably because that was the only explanation for his place in the team? But nine years on, and thousands of disrespectful comments later, Darren Fletcher is now seen as a midfielder in the world-class bracket. United’s world-class midfielder.

But Fletcher has always divided opinion. Some supporters viewed the Dalkeith-born midfielder as little more than decent backup. Others pushed the merits of local talent and not an import.

Fletcher began his career as a much-vaunted creative midfielder. Club insiders had earmarked the Scot for Beckham’s right-wing slot.

“Ferguson is convinced that in teenage prodigy Darren Fletcher, he has a youngster who will make a sensational impact when he breaks into the first-team. The 16-year-old Scot, already rated Beckham’s understudy, is so integral to Ferguson’s future plans that the manager took the lad into his own home to convince him to move to Old Trafford,” was ESPN’s analysis in 2000.

But Fletcher’s first few seasons at Old Trafford, hampered by serious injury, slowed the player’s development into the central midfielder Ferguson relies upon today. Fletcher did not convince everybody – famously the Scot was singled out by Roy Keane for public criticism.

“I can’t understand why people in Scotland rave about Darren Fletcher,” the Irishman reportedly said.

Fletcher’s progress stalled, with Ferguson’s preferred midfield of Cristian Ronaldo, Paul Scholes, Michael Carrick and Ryan Giggs blocking his path to a regular game. The arrival of Owen Hargreaves and Anderson made Fletcher’s departure seem all but inevitable. There were even rumors that Fletcher considered leave the club.

In many ways 2009 was a watershed in Fletcher’s career. The Scot fought his way back into the first team picture, with a string of stellar performances. More to the point, Ferguson illustrated Fletcher’s increasing importance to the team by leaving the midfielder out of Carling and FA Cup games.

The Scot’s red card against Arsenal in the Champions League semi-final may have devastated Fletcher personally but United’s performance in the final highlighted only served to highlight his newfound importance to the team.

But perhaps the highest praise came from former-Liverpool legend Graeme Souness.

“I believe he will be, arguably, United’s most important player for the next seven years,” claimed the 54-cap Scot.

It has been a different path for John O’Shea to first team success. Possibly United’s most versatile player, O’Shea has been through the ups and downs of playing for the world’s greatest club since joined at 17. Making his début in 1999, after loan spells at Bournemouth and Belgian side Royal Antwerp, O’Shea benefited from his versatility to force his way into the first team squad.

But the Irishman’s biggest stroke of luck came in 2004 when Rio Ferdinand, suspended for missing a mandatory drugs test, handed O’Shea a home in central defence. O’Shea helped United triumph in that season’s FA Cup Final.

However, poor form the following year led to speculation that O’Shea would leave the club, linked as he was with a move to Newcastle United and Liverpool. Injuries to Gary Neville in 2006 offered the defender further opportunities in the first team but he failed to impress and was another player condemned by Roy Keane in the now infamous MUTV outburst.

But just as O’Shea’s United future looked dire, the Waterford-born player managed to win his way into supporters’ hearts with a solid performance against Tottenham Hotspur – in goal - following Edwin van der Sar’s injury. Then O’Shea scored an added-time winner against Liverpool at Anfield to cement his status. During the 2008 season, O’Shea even played as an emergency striker giving the Irishman the unique distinction of having played in every position for the team.

Last season O’Shea was a key player for United, scoring against Arsenal in the Champions League semi-final first leg. He finished the final as one of United’s better players.

O’Shea’s status as first choice right-back has continued, even captaining the side against Birmingham City this term. At Stoke City O’Shea played – and scored in – his 350th appearance for the club. A remarkable achievement for the man so few had believed in.

“I could play John anywhere. He has great passing awareness, two good feet, he is quick, and he is balanced. He’s athletic, big and gets around well,” is Sir Alex Ferguson’s summary of the player’s newfound importance to the team.

While some still criticise O’Shea for being mediocre, he is now a vital part of the United squad. This is unlikely to change, after all how many players can Sir Alex trust in almost any position?

Three different players: Evra, Fletcher and O’Shea. Each has been subject to criticism from fans. Each has suffered on the road to stardom. But now United can boast the world’s finest left back, a world-class midfielder and John O’Shea … well he’s pretty awesome too.

“It was a penalty,” Fletcher said.

“I turned and the lad swept my feet away. I didn’t try to fall, he just swept my feet away.

“When the referee blew his whistle, my first thought was, ‘Great it’s a penalty, we can get back in the game’ and then he started walking towards me with the yellow card and I couldn’t believe it.”

Sir Alex Ferguson called referee Olegario Benquerenca’s decision the worst he had seen in more than 50 years in the game.

“You can’t appeal a yellow card – it is crucial because to miss an important game because of that is unfair. They should look at that but they won’t,” the United manager said.

In last season’s semi-final Fletcher, suspended for the 2008 Champions League final following a red card against Arsenal, appeared to get the ball before felling Cesc Fabregas.

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“On the injury front I can’t give a clear picture, there are still some doubts about Rooney and Fletcher,” Feguson told Sky Sports News.

“Patrice (Evra) is fit, and Ryan (Giggs) is also fine, but Ji-Sung Park is definitely out unfortunately.

“Everyone is fit from after Wednesday’s game in Moscow.”

Wayne Rooney, suffering with a calf strain picked up on international duty, missed the victory over CSKA Moscow Wednesday. United’s leading marksman this season with seven goals, Rooney’s loss would be a huge blow to United’s hopes of ending Liverpool’s tilt at the Premier League this season.

Fletcher, who also missed the Moscow tie, has become the mainstay of the United midfield with perennially crocked England international Owen Hargreaves missing for more than a year.

If the pair fail to make the match Ferguson may opt to deploy a five-man midfield, with Ryan Giggs in support of lone striker Dimitar Berbatov. Michael Carrick and John O’Shea will fight it out for the holding role in midfield should Fletcher miss the game.

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“I don’t want to be pigeonholed as a destroyer,” Fletcher told the Sunday Telegraph.

“The whole idea is to become an all-round midfielder, who can pass the ball, score goals and get the team going.

“I can be a destroyer when we don’t have the ball and set a high tempo and be the trigger. When we don’t have possession, I’m thinking, ‘right, I’m going to be the first one to press and win it back’.”

Fletcher says that the departures of Cristiano Ronaldo and Carlos Tevez has given him the opportunity to join the attack and score more goals in the past. To become the all-rounder Fletcher must improve on his record of 15 goals in 221 appearances for United.

“The manager has pointed out that Ronaldo has gone and that is a huge goal difference that we need to fill. As players, we all have to rise to the challenge,” he said.

“Ronaldo was good for us, but a lot of players sacrificed themselves for Cristiano too. In a lot of games, I’d be asked to play in central midfield but, whenever he went forward, I’d have to get out to the right to cover him.

“Maybe, now we have got back to 4-4-2, where everybody drops back as a four, it gives the midfielders more opportunity to bomb forward.

“I’d like to think I can get double figures this season because, in this team, you are always likely to get chances if you can get into the box.”

With two goals against Manchester City last weekend, Fletcher is well on the way.