That form and function relates, is the maxim to anatomy and physiology. Yet form-function relations can be difficult to establish. Human subjects with excessive trabeculated myocardium in the left ventricle, for example, are diagnosed with non-compaction cardiomyopathy, but the extent of trabeculations may be without relation to ejection fraction. Rather than rejecting a relation between form and function, we may ask whether the salient function is assessed; is there a relation to electrical propagation, mean arterial blood pressure, propensity to form blood clots, or all? And how should extent of trabeculated muscle be assessed? While reviewing literature on trabeculated muscle, we applied Tinbergen’s four types of causation - how does it work, why does it work, how is it made, and why did it evolve - to better parse what is meant by form and function. The paper is structured around cases that highlight advantages and pitfalls of applying Tinbergen’s questions. It further uses the evolution of lunglessness in amphibians to argue lung reduction can impact on chamber septation, and it considers the evolution of an arterial outflow in fishes to argue that reductions in energy consumption may drive structural changes with little consequences to function. Concerning trabeculations, we argue they relate to pump function in the embryo in the couple of weeks before the onset of coronary circulation. In fetal and postnatal stages, a spectrum of trabeculated-to-compact myocardium makes no difference to cardiac function and in this period form and function may appear unrelated.