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starting quarterback , who has struggled with shoulder and forearm problems since suffering a Grade III separation of his right shoulder on Sept. 30, will likely need at least two more weeks of rest and rehabilitation, and even then might still require surgery to repair the damage.

The first overall choice in the 2005 draft, Smith was examined on Tuesday by noted orthopedic surgeon Dr. James Andrews in Birmingham, Ala. Sources close to Smith said Andrews apprised the third-year veteran 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 ago. A 49ers spokesman said the team’s medical staff had not received the Andrews report.Smith will return to the Bay Area and undergo more rehabilitation. He will be reevaluated in about two weeks and, if there is no improvement, surgery might be indicated. Given the results of Andrews’ examination, there apparently is some possibility now that Smith will not play again in 2007. Until Tuesday, Smith had not visited with Andrews in person since the injuries. Andrews had, however, studied the MRI results and other tests conducted in San Francisco and had essentially served as a consultant to the 49ers’ medical staff. Smith, 23, complained last week 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 at mid-week but that did not markedly improve the condition. 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 last week 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. 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, then missed two games before returning to the lineup for three contests. With his arm clearly aching — some opponents and teammates said Smith grimaced nearly every time he threw the ball — he sat out last Sunday’s game and veteran started. Dilfer will remain the starter for Sunday’s upcoming game at Arizona, and likely for the foreseeable future. Senior writer Len Pasquarelli covers the NFL for ESPN.com