A rib removal requires an operation on the thorax. This surgery is called a thoracoplasty. A single rib removal is sometimes performed on the first rib for nerve compression. This condition is also called thoracic outlet syndrome.

Accessory rib is often the cause of the thoracic outlet syndrome. In the past, pulmonary tuberculosis (see Diagnostic Code: 6730 Tuberculosis, pulmonary chronic, active) was an indication for a thoracoplasty. Lung cavities from tuberculosis were collapsed with this method. This procedure is now done infrequently due to more recent treatment methods for the condition.

Signs and symptoms after several ribs are removed would be similar to those experienced by a patient who has had a partial pneumonectomy. There would be decreased breath sounds on the operative side; possible shortness of breath; lateral chest deformity resembling scoliosis; and possible reduced arm and shoulder movement on the operative side. Preoperatively, some of the cervical rib symptoms include pain in the arm and shoulder; weakness; paresthesia; and claudication. Surgery usually relieves these symptoms.

Diagnostic tests used for a thoracoplasty and tuberculosis (see Diagnostic Code: 6730 Tuberculosis, pulmonary, chronic, active) include: chest x-ray; bronchoscopy; laboratory screening tests; and sputum examinations and cultures. Diagnostic measures for a thoracic outlet syndrome would include: physical examination; chest x-ray; electromyogram; and auscultation for bruits.

When conservative medical management is not successful, then rib removal is the treatment.

A thoracoplasty results in visible chest deformity on the operative side. A form of contraction atelectasis may occur. Cervical rib syndrome may result in small arm muscle atrophy.

• The rating schedule for musculoskeletal was updated on February 7, 2021. Protection still does apply and should be considered with existing evaluations (38 CFR 3.951(a)).

• The rating for rib resection or removal is not to be applied with ratings for purrulent pleurisy, lobectomy, pneumonectomy or injuries of pleural cavity.

• However, rib resection will be considered as rib removal in thoracoplasty performed for collapse therapy or to accomplish obliteration of space and will be combined with the rating for lung collapse, or with the rating for lobectomy, pneumonectomy or the graduated ratings for pulmonary tuberculosis. 38 CFR 4.71a [Schedule of ratings-musculoskeletal system]