Berry's left shoulder popped out for the second time in five weeks when he reached to tackle Collingwood superstar Nick Daicos at the MCG on Saturday night.
The 27-year-old spent several minutes in pain and eventually made his way off the ground, with umpires stopping play as the Magpies were about to launch an attack.
Berry, who was replaced by Bruce Reville, was also subbed out of Brisbane's win over Fremantle in round 23 with a dislocated shoulder, before returning three weeks later in the qualifying final against Geelong.
But he appears highly unlikely to play in next Saturday's season decider against the Cats after re-injuring the same joint.
Lions teammates Josh Dunkley (ankle) and Ty Gallop (ribs) required treatment on injuries in the preliminary final but played out the match.
Two-time Brownlow medallist Lachie Neale would be a perfect replacement for Berry but is at long odds to overcome a calf injury sustained in the qualifying final.
Collingwood legend Scott Pendlebury also would've been in huge doubt for the grand final if his side had advanced.
Pendlebury was an early casualty in the prelim when he injured his left calf and was subbed out after just 10 minutes.
Magpies football boss Charlie Gardiner said Pendlebury experienced "calf tightness" and didn't respond to treatment.
"It didn't get better so we decided to sub him out and not take any risks with him," Gardiner told Seven at half-time.
Pendlebury was seen in a lengthy discussion with club doctors before the match, but Gardiner dismissed suggestions the veteran carried an issue into the contest.
"No, I don't think so," Gardiner said.
"No. He was fine going in, he just developed some tightness in his calf 10 minutes in."
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