Niners' Alex Smith hopes to avoid shoulder surgery

Alex Smith is hoping two weeks of complete rest for his ailing right shoulder will helphim avoid surgery and allow him to return for the San Francisco 49ers' final few games.

It's too early to tell whether the quarterback's shoulder agrees with the plan.

Smith hasn't thrown a pass in nearly two weeks, and he doesn't even lift his arm above his shoulder unless it's absolutely necessary. The former No. 1 draft pick hopes enough scar tissue will build up around his ligament to give him a comfortable throwing motion, but he won't know until picking up a football.

Smith has consulted with Dr. James Andrews and the 49ers' training staff while trying to solve the problems in his throwing motion since his shoulder was separated on a sack during a game against Seattle on Sept. 30. He'll speak with the same team again next week while trying to decide whether to undergo surgery and the resulting three-month rehabilitation.

“In talking to them, it's something that if you can at all, you want to avoid surgery, especially on your throwing shoulder,” Smith said Thursday. “After a surgery, some quarterbacks can still feel it in their motion, and some continue to play 10 or 12 more years with it.”

Smith struggled through three games with his sore shoulder and the resulting strains in his forearm before publicly complaining about his problems two weeks ago. The 49ers decided to rest their franchise quarterback for at least two games, turning over the team to backup Trent Dilfer for the second time this season.

Smith probably won't be active when the 49ers (3-8) visit Carolina on Sunday. He wasn't in uniform last week when Dilfer led San Francisco to a 37-31 overtime win at Arizona, snapping the Niners' eight-game losing streak.

“Gripping a football and throwing it as hard as I can, that's when I feel it the most,” Smith said. “When I follow through, I really feel it in my collarbone.”

Coach Mike Nolan, who publicly sparred with Smith over their misunderstandings about the severity of his injury, has effusively praised Dilfer's play in the 49ers' last two games. Nolan hasn't decided whether Smith would go back in the starting lineup even if he's healthy enough to play in the final four games.

“I don't have to make that decision right now,” Nolan said. “We'll take it one game at a time.”

Until Dilfer's strong performance against Arizona, neither quarterback had done much of note in the NFL's worst offense. Among all NFL quarterbacks who qualify for league statistics, only the Jets' Kellen Clemens has a poorer passer rating than Smith (57.2) and Dilfer (62.8).

Both San Francisco quarterbacks' completion percentages also are worse than every quarterback except Clemens, but Dilfer has thrown five touchdown passes – and he led the 49ers' only victory in more than two months.

“I didn't play as well as I'd like to earlier in the year, when things didn't go well,” Dilfer said. “But you just try to keep improving on the things you're not doing well. If there's one thing I am, it's resilient. … The more you play, the more comfortable you get, and there's a rhythm with the people around you. If you keep getting better each week, it's eventually going to make a difference, and that's what happened in Arizona.”

Though Smith has openly pondered the consequences of shutting himself down for the season, he doesn't seem ready to give up just yet. He still attends every position meeting with Dilfer, third-stringer Shaun Hill and practice squadder Drew Olson, preparing himself in case he feels better next week.

“Definitely, if at all possible, I want to avoid (surgery),” Smith said.

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