Matria ( MATR), Zimmer ( ZMH) and Express Scripts ( ESRX) are all hurting after disappointing investors with their latest quarterly updates.

The big healthcare players saw their shares drop sharply Thursday after mixed performances on the earnings front, as the stock market swooned under rising fears tied to the debt markets.

Matria suffered the most pain, by far, as its stock weathered a double-digit percentage loss on reduced full-year guidance. The company, a specialist in disease management and wellness services, now expects to generate 2007 sales of just $355 million to $363 million -- well below the $374 million consensus estimate -- due to delays in some major contracts. The company lowered its full-year profit outlook by 14% to $1.42 to $1.55 a share, excluding stock-option expenses, as well.

After watching Matria set the bar too high in the past, Wall Street experts have seen their fears play out once again.

"Our biggest concern with Matria had been the projected earnings ramp in the back half of the year," Credit Suisse analyst Michael Glynn wrote on Thursday. "While this concern is reduced with the new guidance range, we are perplexed at how two new accounts could affect earnings so much.

"We are concerned there are other fundamental factors."

Therefore, Glynn remains on the sidelines with a neutral rating on Matria's stock. His firm has investment banking ties to the company.

Meanwhile, Matria claimed that it met expectations for the second quarter. However, the company's revenue of $88.1 million and its operating profits of 22 cents a share actually fell a bit shy of consensus estimates.

For its part, Matria seemed apologetic -- but ultimately optimistic -- when announcing the news on Thursday.

"We are disappointed that we have to reduce our guidance," CEO Parker "Pete" Petit stated. But "we still see increasing demand from numerous sources for disease management and wellness services. Thus, we are quite busy preparing ourselves for these future opportunities."

Investors were pretty busy selling Matria's stock in the meantime. The shares tumbled 15% to $25.85 on Thursday and now hover in the low end of their 52-week range.

Zimmer took a hard hit as well. Shares of the giant orthopedic device maker spiraled 6.7% to $81.72 following a revenue shortfall and a lack of improved guidance.

Zimmer's second-quarter sales, while up 10% to $971 million, missed the $975 million consensus estimate. Net income rose 14% to $232 million, with operating profits of 98 cents a share matching Wall Street targets exactly. Full-year earnings guidance remains at $4.03 a share, in line with current projections, instead of rising as some investors had hoped.

Moreover, Zimmer's most celebrated new product -- the Gender Solutions knee for women -- no longer looks like a sure-fire hit. Indeed, the company's second-quarter knee sales growth trailed the market rate despite the full roll-out of this highly publicized device.

Leerink Swann analyst Jason Wittes portrayed the knee's recent performance as "less than exciting" when reiterating his market-perform rating on the company's stock on Thursday. His firm provides consulting services to companies in its coverage universe.

"Without Gender knees as a real catalyst, we see no fundamental reason to own the stock here," Wittes emphasized. Meanwhile, "our price valuation of $82 to $86 a share is under review."

Express Scripts weathered the smallest drop of the three on Thursday, although some felt that strong second-quarter results should have better supported the stock.

The giant pharmacy benefit manager saw profits surge 42% to $153 million -- with earnings per share of 56 cents topping Wall Street estimates by 2 pennies -- due to rising sales of high-margin generic drugs. The company expects that momentum to continue and has, therefore, raised its guidance for the full year.

Specifically, Express Scripts now expects to generate profits of $2.23 to $2.29 in 2007. That forecast is 8 cents higher than its previous range -- and comfortably above the $2.21 consensus estimate -- but includes the release of some unnecessary reserves.

Investors, hoping for more, pushed the company's stock down 3.9% to $49.98 on Thursday. However, the shares still remain near the high end of their wide 52-week range.

Still, Leerink Swann analyst Ann Hynes foresees more upside ahead. She reiterated her outperform rating on Express Scripts' stock following the company's solid second-quarter results. Her firm makes a market in the company's securities.