Still experiencing pain in his right shoulder, San Francisco 49ers starting quarterback Alex Smith might be close to resolving the issue of how best to treat the injury, and that could include the possibility of not playing again in 2007.
Smith told Bay Area reporters on Thursday that, even after nearly two weeks of rest, he still can't raise his right arm above his shoulder without discomfort. He will visit early next week with an orthopedist, and surgery remains a viable option for the top overall selection from the 2005 draft.
"Hopefully, we'll get some answers and clarity next week," Smith told reporters. "Those ligaments haven't healed at all. Hopefully, [the rest] will allow them to start healing. ... I really feel my collarbone moving when I come through on my throwing motion."
Smith, 23, suffered a Grade III separation of his right shoulder on Sept. 30. While he was rehabilitating the injury, he experienced pain in his right forearm. He hasn't played since a Nov. 12 game at Seattle and hasn't thrown since Nov. 18.
ESPN.com reported on Nov. 20 that Smith, after being examined by Dr. James Andrews, was apprised by the noted orthopedic surgeon that the shoulder separation was not significantly improved and might actually be worse in some ways than when he initially viewed the original MRI of the injury three weeks earlier.
Andrews prescribed two weeks of rest and then a re-evaluation, and he acknowledged surgery might be necessary to correct the damage to the shoulder. Smith will meet early next week with either Andrews or Dr. Tim McAdams, the 49ers' team orthopedist. That follow-up examination could determine whether Smith undergoes surgery or continues treatment with the hope of playing again this season.
The three-year veteran has already been ruled out for Sunday's game at Carolina and 14-year veteran Trent Dilfer will make his third straight start.
"You would like to avoid surgery if at all possible, especially to your shoulder," said Smith, who emphasized that he would like to try to play again this season if that is feasible.
If Smith does have surgery, he will face months of rehabilitation.
Two weeks ago, Smith complained that his throwing arm was "killing" him and revealed that, in addition to the shoulder separation, he had developed tendinitis in his forearm. He had a cortisone injection for his forearm soreness but that did not markedly improve the condition.
Smith's agent, Tom Condon of CAA, suggested that the tendinitis, which kept Smith from being able to grip the ball properly and almost certainly contributed to his recent inaccuracy, may have resulted from an overly aggressive rehabilitation regimen on the part of the 49ers.
There was definitely some tension earlier in the month between Smith and head coach Mike Nolan. The quarterback broadly hinted that Nolan was perhaps not as supportive of him as he could have been. Nolan indicated that he may not have understood the seriousness of the injury and said that Smith wanted to play.
Both sides eventually agreed that, at the least, there was a lack of communication. Condon agreed that nobody had the correct information.
"The original MRI didn't show the severity of the injury, but Dr. Andrews said that's because Alex was laying down when he had the MRI," Condon said. "Whenever Alex sat up during the [Nov. 20] exam, his clavicle moved way up. That's not normal."
In his seven starts this season, Smith has completed 94-of-193 passes for 914 yards, with only two touchdown passes and four interceptions, for a passer rating of 57.2. Perhaps in part because of the shoulder and forearm injuries, the former Utah star has appeared to regress in some areas over his performance of a year ago.
Smith started the first four games of the season before sustaining the shoulder separation and then missed two games before returning to the lineup for three contests. With his arm clearly aching and his production waning, some opponents and teammates said Smith grimaced nearly every time he threw the ball.
Len Pasquarelli is a senior NFL writer for ESPN.com.