The San Francisco 49ers medical staff has had a busy season thus far. The team has sent 22 players to injured reserve since head coach Kyle Shanahan took the reigns. Numbers 21 and 22 on that list were safety Jaquiski Tartt, who suffered a broken forearm on Sunday against the Arizona Cardinals, and tight end Cole Hikutini, who sustained an MCL injury in the same game.

A 23rd, tackle Garry Gilliam, is also expected to land on injured reserve this week with an MCL injury sustained during a Week 8 contest against the Philadelphia Eagles.

The 49ers lead the NFL in at least one category – players on injured reserve. That's a tight spot for an already young team that is still fighting for its first win.

"I know our guys have been playing real hard," Shanahan said on Monday. "We've been playing some long games and battling and some physical games, and injuries happen. I've never been a part of a team where it's been like this, but teams do have to deal with this type of stuff all the time, especially this time of the year."

Outside of those on or headed to injured reserve, at least 10 other 49ers players are expected to miss or be limited in practice this week due to injuries. That list includes, but is not limited to, starters like tackle Joe Staley (eye), fullback Kyle Juszczyk (neck), tight end George Kittle (knee), defensive lineman Solomon Thomas (knee), and linebacker Reuben Foster (ribs, ankle).

Foster actually played a complete game on Sunday, which was the first time he finished a game in his young NFL career.

Kittle, wide receiver Trent Taylor (ribs), and linebacker Elijah Lee (knee) will all miss Sunday's game against the New York Giants, according to Shanahan.

This year isn't the first time Shanahan has been part of a losing season. It is, however, the first time he has been the head coach of a 0-9 team. It's not the start that he and general manager John Lynch envisioned when they began to sculpt the team's roster.

"I feel like I've been through a lot of adversity in my career," Shanahan said. "I think I've been in some tough situations. I think I've learned a lot about myself over the last 10 years. I think that's what's put me in position to handle stuff like this. We're 0-9, and I promise you guys that is not a good feeling for me. It's something that I don't accept. It's something that I'm not pleased with at all, and I'll never change until that changes. But, I also do have perspective.

"I've been through a lot of things, and for that reason I know I can handle stuff like this. I think I am battle tested. I know the guys at work are going to get the same person from me every day, regardless. And I know I'm going to do the best I can, and I expect the same from our players.

"I know not everyone's been through stuff like this. I haven't been through this exactly. But, everyone's had their different tough moments, and there is not a doubt in my mind we'll get through this. It's when are you going to get through it? That doesn't necessarily matter. It's when you get through it, are you going to be better from it or worse? And I know I'll be better, and I expect our team to be better."

With so many injuries, the 49ers are scrambling just to field a football team for Sunday's game against the Giants.

"We're going to have to sign some guys," Shanahan said. "We plan on signing some guys here in the next couple days. I know they're working on it right now, into tomorrow. So, we're going to have to figure that out before (our first practice of the week on) Wednesday."

On Monday evening, San Francisco made moves to fill the roster by bringing back two players who spent time with the team this year. The first is wide receiver Louis Murphy, who signed with the 49ers on July 31 and was waived on September 1. The second is tight end Logan Paulsen, who appeared in each of the team's first seven games this season but was released on October 24.

The 49ers don't have many options available to get bodies on the roster. With the trade deadline having come and gone, the pool of available NFL players is limited.

"Anybody that we have on practice squad versus the options that are out there that aren't under contract with other teams to people who are on other team's practice squads," Shanahan said, "those are your three choices this time of the year."

The winless 49ers host the one-win Giants at Levi's Stadium on Sunday. It is San Francisco's final game before its much-needed bye week.