MARK Cavendish's Tour de France could be over after he was taken to hospital with his right arm in a sling having crashed in a chaotic finish to stage four, which was won by Frenchman Arnaud Demare.

Dimension Data rider Cavendish fell heavily after taking a nudge from world champion Peter Sagan in the final 150 metres in Vittel.

The Manxman indicated his Tour may be finished after he injured the same shoulder he hurt in the 2014 Tour – when he crashed in Harrogate.

"Injury-wise I'm going to go and get it checked out. I definitely need stitches in this finger, it's bleeding a lot," he said.

"And the shoulder, there's something to do with that previous shoulder that I did in Harrogate – it's just sat backwards. I don't know if I've snapped the fake ligament in or what.

"I'm going to go and get it looked at. I'm not a doctor, I don't know what, but I'm not optimistic anyway."

Bora-Hansgrohe rider Sagan was penalised 30 seconds for his role in the crash, costing him second place on the stage and second overall as he would have moved above Chris Froome with the time bonuses on offer.

Cavendish fell in the second of two late crashes on the stage from Mondorf-les-Bains, with the other sending race leader Geraint Thomas of Team Sky to the ground in the yellow jersey.

However, the Welshman was quickly up and on his way, with the maillot jeune safe as times were neutralised with both crashes inside the final three kilometres.

The news looked much worse for Cavendish, who was pushed into the barriers just 120 metres from the line.

The stricken Manxman in turn brought down UAE Team Emirates' Ben Swift and Trek-Segafredo's John Degenkolb – the latter trying to bunny hop over Cavendish to avoid a direct collision.

Cavendish said: "I was just following Demare and Sagan came over. I get on with Peter well but I don't get the elbow. I'm not a fan of him putting his elbow in me like that.

"A crash is a crash, I'd just like to know about the elbow really."

Cavendish, a 30-time Tour stage winner, had recovered from a long bout of illness to make it to the Tour this year as he sought to close in on Eddy Merckx's all-time record of 34 Tour stage wins.

Sagan visited the Dimension Data bus after the finish to check on Cavendish and said: "Mark was coming pretty fast from the back. I tried but didn't have time to react to go left. He came to me and I had to defend."