Sunderland's depleted squad lost John O'Shea to injury, and their misery was compounded by a sensational double from Cristhian Stuani.
Cristhian Stuani scored two brilliant goals as Middlesbrough earned a 2-1 win over Sunderland in the Wear-Tees derby at the Stadium of Light, with David Moyes' injury problems continuing to pile up.
After his 25-yard stunner flew past Sunderland goalkeeper Vito Mannone in the 13th minute, Stuani rounded off a neat team move before the interval to inflict defeat upon Moyes in his first home match in charge.
Moyes' concerns will be even greater after the loss of John O'Shea to injury in the first half, his exit further stretching a squad already depleted by the enforced absences of Sebastian Larsson, Jan Kirchhoff, Lee Cattermole, Billy Jones and Lamine Kone.