Introduction: Bicipital rib results due to fusion of cervical rib with the first or the first rib with the second rib. Its incidence has been reported to be 0.3% based on chest radiography. Observation: During routine course of osteology teaching we noticed left sided first rib which had fused with the second rib on its superior surface, 1.5 cm from the tubercle of first rib obliterating the first intercostals space anteriorly. Single articular facet was present on the heads and tubercles of both the ribs. Conclusion: A Rib anomaly usually indicates an underlying systemic disease and might need surgical intervention. First rib anomaly is an uncommon cause of thoracic outlet syndrome hence should not be neglected. The present paper is an attempt to highlight its morphological implications and clinical significance.