Smith went down near the end of the third quarter when he took a hard hit to his throwing arm. He missed the remainder of that possession and two more before he returned for the final drive, getting Seattle in position for a potential winning field goal that Jason Myers missed from 55 yards out.
The Seahawks' 17-16 loss dropped them to 6-4 and a full game behind the 7-3 49ers in the NFC West after their win Sunday. Smith's injury, meanwhile, puts his status for Thursday night's game against San Francisco at Lumen Field in question.
Smith was still in pain when he spoke with reporters postgame.
"We'll see how it goes," he said when asked about his chances of making the quick turnaround to play on Thanksgiving.
Coach Pete Carroll said the hit bruised the back of Smith's elbow in his triceps area and "kind of blew up a little bit."
"I don't have any idea," Carroll said of the likelihood of Smith playing Thursday. "I have no idea. Sorry."
The Seahawks also lost running back Ken Walker III to an oblique injury in the first quarter. He had five touches for 16 yards on Seattle's opening touchdown drive but didn't play the rest of the way. Carroll said he didn't know whether Walker will be available Thursday but called it a "legit" strain -- a word he typically uses to describe injuries that will cause a player to miss time -- and said Walker could hardly move because of it.
"No, he's pretty sore though, I know that," Carroll said. "Yeah, it was legit."
Smith was hurt while throwing on the second-to-last play of the third quarter when he was hit by Aaron Donald. He was examined on the field then walked to the sideline for further evaluation. After leaving the medical tent, he attempted a few short passes on the sideline while grimacing in pain and trying to extend his elbow between throws.
Smith had an ice wrap placed around his elbow on two separate occasions, with another brief throwing session in between. He threw again after getting the ice wrap removed a second time but still did not appear comfortable.
Meanwhile, Drew Lock took over for the final two plays of the drive in which Smith was hurt and two full possessions after that. He went 2-of-6 for 3 yards and an interception on a deep throw down the sideline to Tyler Lockett, who regretted not making a better play on the ball.
"The dude made a great play," Lockett said of cornerback Derion Kendrick. "It's one of those things where probably looking back if there was anything that I could change it would probably be one of those things where if I can't get it, nobody could get it."
Lock's other two possessions ended with punts. With Smith on the sideline, the Rams scored a touchdown to cut Seattle's lead to 16-14 then drove for a field goal to go ahead 17-16. That drive was kept alive by a penalty on cornerback Riq Woolen for illegal use of hands, which negated a third-down stop. That was one of 12 Seahawks penalties for 130 yards. According to ESPN Stats & Information, that was the most penalty yardage in the NFL this season and Seattle's most since 2018.
Woolen, who intercepted Matthew Stafford two possessions earlier, disagreed with the penalty -- both because he was so far away from the play and because he didn't think he got his hand to receiver Austin Trammell's helmet.
"It was some BS," Woolen said. "But at the same time, I'm hard on myself so I feel like that's on me. I feel like in those situations, we're supposed to get off the field and the game is supposed to be over right there."
The Seahawks had no timeouts remaining, 1:31 left on the clock and the ball at their own 25-yard line when Smith returned for the final drive. He completed three of his first four attempts for 36 yards, including a 21-yard gain to DK Metcalf that got Seattle to the Rams' 39.
Instead of spiking the ball to stop the clock with 23 seconds left, the Seahawks handed off to Zach Charbonnet for a two-yard gain then clocked it with nine seconds remaining to set up Myers' winning attempt.
Carroll lamented how the Seahawks handled that sequence, saying they "didn't do it right" without getting specific. He acknowledged that one option would have been to spike the ball after Metcalf's catch, leaving them with one or two plays to cut down some of the yardage on Myers' kick.
"We didn't quite handle that as well as we'd like to, but we got in field goal range," Carroll said. "We got there and we had a shot. Jason's kicked balls from that far before. We'd loved to have been a little bit closer but obviously we weren't."
Smith, speaking after Carroll, revealed that the receiver inside his helmet, which allows him to hear the playcall from offensive coordinator Shane Waldron, cut out after Metcalf's catch.
"I guess there was an outage or something, but no play came in my helmet so I called the quickest play I could in that situation," he said. "Try to maybe get a few more yards. Called a run play. Thought we had a chance, and it really didn't work out how we thought it would."
Smith said that happens more than observers may realize, though it was the only time it happened Sunday. Asked if he thought that was curious given the timing, Smith said, "I mean, I don't know. I'm just worried about the game, trying to win."
Myers went 5-for-5 last week, including the winner as time expired to lift the Seahawks over the Washington Commanders. He made his first three field goal tries Sunday, hitting from 54, 43 and 52 yards out before missing wide right on the final kick.
Myers said the snap and hold were good, and that he got the contact he wanted.
"It's tough because it's indoor but it's not," he said. "It's pretty windy in there. So I knew I kind of had to drive it a little bit. So yeah, it was a tough kick."
Smith finished 22-of-34 for 233 yards and a touchdown pass to Metcalf. It was his second straight game without a turnover after committing eight in a four-game span.
"He gave us a chance," Carroll said. "Gave us a chance to kick the ball and win it. Long field goal, for sure. You couldn't have a better guy to kick that one. Jason has been doing great and he just didn't get a good hit on the ball this time but he's exactly the right guy to win the game for us obviously. We know that."
Including playoffs, Seattle is now 5-10 against the Rams since coach Sean McVay took over in 2017.
Lock, 27, didn't play a regular-season snap for the Seahawks last season after they acquired him in the Russell Wilson trade in March 2022. He briefly took over in the Seahawks' win over the New York Giants in Week 4 after Smith hurt his knee, going 2-of-6 for 63 yards. He has an 8-13 career record as a starter, a role he hasn't filled since the final three games of the 2021 season with Denver.
Carroll was asked about his confidence in Lock's readiness to start Thursday night if needed.
"Shoot, we're going to count on him to win the football game," Carroll said.