DAVID MOYES claimed Patrick van Aanholt was a last-minute withdrawal from Sunderland’s 1-0 defeat to Tottenham because of “medical reasons” – but mystery continues to shroud the precise explanation for the Dutchman’s non-appearance at White Hart Lane.

Harry Kane’s second-half strike means Sunderland have picked up just one point from their opening five league games, but the main post-match debate centred around the late decision to remove van Aanholt from the starting line-up.

The Dutch full-back was included on the initial team sheet that was submitted to Premier League officials, and took part in the pre-match warm-up as usual.

However, it became clear something was amiss when Moyes became embroiled in a lengthy discussion with his assistant, Paul Bracewell, and Sunderland announced that van Aanholt would no longer be playing around ten minutes before kick-off.

Jason Denayer took his place in the starting XI, with Javier Manquillo switching flanks to play at left-back, and Sky Television pictures quickly emerged which appeared to show Denayer informing a clearly shocked van Aanholt that he would no longer be playing.

Van Aanholt appears to say, “Who me? You’re joking”, before kicking the ball away, but Moyes insists the Dutchman was suffering from a medical complaint, even if he would not expand on the nature of the problem. Van Aanholt watched the game from the substitutes’ bench, and did not seem to be in any obvious discomfort as he left White Hart Lane to walk to the team coach.

“I’ve given a stock answer – medical reasons – as to why we chose to withdraw him from the game,” said Moyes. “If you don’t mind, I won’t follow up on that. I’m giving you what I think is the best answer just now.

“It’s difficult to make a late change, but it meant that we could give Jason Denayer some game time, which is a good thing. I thought Javi Manquillo went over to the left and did okay, and he played for Marseille in that position a lot last season.

“From that point of view, we did what we thought was the right thing to do, and set up as best we could.

“We advised the referee very late on. I got word of something very late on, and because of that it affected the decision we made. As you know, people can get injured in the warm-up and you can make changes.”

The late alteration meant Sunderland were forced to field a completely untried back four, and their defence spent most of the afternoon mounting a frantic rearguard action in the face of some incessant Spurs attacking.

The hosts scored with their 22nd shot of the game, a statistic that underlines the extent of their dominance, yet they still might not have made a breakthrough had Papy Djilobodji not failed to deal with Dele Alli’s headed knock-down in the area, enabling Kane to sweep home from close range.

“We were in the game, but we have to be truthful – it was tough,” said Moyes. “Things were whizzing past the post and we were hanging in there.

“But credit to the players, that’s where we are at the moment. We are having to be resilient, hang in games and look to get things.

“We came here trying to get something, but we were always on the back foot right from the start, although we may have had the best chance of the game through Steven Pienaar.”

Pienaar’s opportunity came to nothing when he shot weakly from inside the area, enabling Kyle Walker to hack clear from close to the goalline, and Sunderland’s defeat would have been much more emphatic had it not been for another superb goalkeeping performance from Jordan Pickford.

“He’s got real potential,” said Moyes. “He’s only at the start of his journey, and he is going to get a lot of work, as you can see, but the work he had, he did really well.

“I also thought Dider Ndong played really well for us today, he gave us a youthful energy, legs, and he got around the pitch for us.”

As if the defeat was not bad enough, Sunderland finished with ten men as Adnan Januzaj picked up a red card that will keep him out of Wednesday’s EFL Cup game at QPR. Having been booked for dissent, Januzaj was dismissed for a foul on Ben Davies.

“I was disappointed with Adnan, but I was also disappointed with the referee because it was a free-kick on the edge of the box and you could clearly see he was having his jersey pulled.

“But he (the referee) didn’t give it, and Adnan shouldn’t have spoken back to him. The second challenge could be a yellow card, but it actually looks worse on TV than it did standing pitchside.”