Wednesday, December 30, 2009


Sherlock Holmes (Robert Downey Jr.) is a brilliant sleuth but a lousy anatomist. At the very beginning of this delightful film(1), Holmes narrates a sequence of strikes he is about to execute on an adversary, predicting the physiological results from the various blows he will inflict.

Mr. Downey as Sherlock Holmes.
Get me some barbeque sauce for those ribs(2)!

What is this big faux pas in the context of this narrative? The statement that took me a full three minutes to recover from? Holmes says he's going to punch this guy in his floating ribs, and poke them into his liver. Argh! See what I mean? This is so elementary, my dear Holmes! There are no floating ribs over the upper right quadrant of the abdomen. False ribs, yes. Floating ribs, no. Sheesh!

The liver is the big red blob in the upper right quadrant of the abdomen.
It is nestled up under your diaphragm(3). Some livers make excellent pate.

Everyone has twelve pairs of ribs. True ribs are pairs 1-7. They attach directly to the sternum, in the front of the body. False ribs (rib pairs 8-12) do not articulate directly with the sternum. Ribs 8-10 indirectly attach to the sternum. Floating ribs are pairs 11 and 12. They are called "floating" because they only attach to the thoracic vertebrae and don't make it around to the front of your torso to attach onto the sternum. Do they really float? No. They are anchored by bands of muscle. The tip of rib 11 can often be felt at the side of the waist. Rib 12 is in the back, hovering over your kidneys(4). Floating ribs are always false, but not all false ribs float.

True ribs, false ribs, and floating ribs, grouped above.

If you punch a kidney, you punch floating ribs. You could punch the liver without hitting a rib at all, but you are most likely to hit false ribs 8-10, or rib 7, a true rib(5).

Posterior view of the skeleton.
The floating ribs have the little red arrows pointing to them.

Holmes' lack of anatomical acumen doesn't keep him from incapacitating his enemies with his bare hands. I am not pooh-poohing his prowess in the manly arts, just his medical training. Great movie! Now I am hungry for skirt steak, BBQ ribs, and pate. All washed down with a pint of ale!

1. Yes, delightful. Jude Law and Robert Downey Jr., plus an allusion to resurrectionists and the dissection of criminals after their execution (which would have been a part of English culture even though the Anatomy Act of 1832 opened the non-criminal cadaver door, so to speak) plus fights, plus an evil villain looking (Mark Strong) oh-so-very Jeremy Britt truly makes for one fun movie!
2. I have a very loving and tolerant vegetarian husband.
3. The diaphragm is skirt steak in meat cut vocabulary.
4. Okay, the 11th rib also has some kidney coverage, too.
5. Don't get me started on true ribs.

Friday, December 25, 2009


Who doesn't feel like this at some point during the holidaze?

Answer this question by New Year's Day: List the musculoskeletal injuries that should have been sustained by Ann Darrow (Naomi Watts) during her encounter with the Eighth Wonder Of The World in King Kong (2005).*

Happy Holidays! Time for Avatar!!!!!!!!

*Theatrical cut only! 187 minutes is enough of ANYTHING. Lists need not be in alphabetical order, although it would be helpful.

Wednesday, December 16, 2009


In Casino Royale, Mads Mikkelsen, playing the evil villain, Le Chiffre, "weeps blood." This, in addition to what I assume is asthma, makes him appear eviler.

Why does Le Chiffre weep blood? He tells us not to be alarmed(1), that it is only a derangement of his tear duct. Now, the bloody tears thing is a great theatrical trope. When I heard this statement I laughed out loud in the theater. It reminded me of the people with the bleeding eyes from the X Files episodes 'way back in the... 90's?

If you Google "bleeding tears" on Youtube, you will see a newsreel about this kid, Calvino Inman. He seems to have been diagnosed with hemolacria. That's like diagnosing a person who faints as having syncope(2). I find medical "news" broadcasts infuriating generally, for their tone and sensational tactics. There are also a lame commercials buttressing this clip, so watch at your own peril.

Click here for the Youtube file, I'm only the cinematologist and don't
know how to add video to this blog (yes I'm pathetic.)

This condition seems rather benign if this kid has no other underlying health issues. It looks kind of gruesome, but it doesn't seem fatal. The kid doesn't have asthma, and probably isn't evil, either.

When someone says "tear duct" they are often mistakenly thinking of the lacrimal puncta, two holes on the nose side of the eye, in the upper and lower lid by the pink part in the corner (the lacrimal caruncle.)

These holes lead to the superior and inferior lacrimal canals, which join together to form the lacrimal sac, which dumps fluid (tears) leaving the eye, into the nose, via the nasolacrimal duct.

This is why, when you cry, your nose runs. Your true tear ducts are a series of excretory ducts that squirt tears out of the lacrimal gland along the upper, outer, eyelid. Perhaps he is bleeding from here.

These models cry very convincingly, don't you think? They are so sad!
Their performance might be improved with some real blood on their faces,
flowing from their lacrimal glands.

When Le Chiffre tears up blood, these bloody tears would come from the lacrimal glands, seep across the surface of the eye, making everything look rosy, and then exit into the nose via the route described above. If Le Chiffre bleeds from his tear ducts, the blood would also run out his nose, making him look like a sissy, instead of evil. Calvino Inman gets a bloody nose when he bleeds tears, but he still just looks like a cute and bloody kid.

Le Chiffre should go to an optometrist. You can't avoid a machete blade if your depth perception is screwed up from blood in your eyes. I bet the blood would clot on your contact lenses, too.

1. Who is ever alarmed for the bad guy?
2. Hemo- means blood, -lacr- refers to tears, and -ia is a "state of." So Calvino is in a state of bloody tears. I hope he has insurance to pay for that diagnosis. FYI, syncope means fainting.