Frontman Philip Anselmo told Artist Direct how the song came together. "I know the middle breakdown part was Rex Brown's riff," he said. "It was part of a song called 'Piss' at one time. I did always like that riff because it had a certain Black Sabbath flavor to it." "There were instances where Vinnie Paul would come up with drum patterns and we would all fall in accordingly," Anselmo continued. "'Use My Third Arm' sort of reminds me of how a song like 'Primal Concrete Sledge' started out. Here's Vince playing this massive percussive part. Dimebag Darrell is looking at me, and I'm looking at him like, 'F--k man, let's do something. This thing kicks ass. Where's the riff?' [Laughs] Dimebag and Rex would fall in accordingly. We'd get to start shaping the song up and putting into a structure that made sense and was best for the song."
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