In many hand and wrist surgeons’ offices, you will see that the most common reason for patients seeking consultations is wrist pain. Patients come from a wide range of sources, including athletes, typists, and grocery store portioners. The physician often attributes the patient’s complaints to the typical symptoms and history specific to a definite injury or illness, and through careful physical examination and standard x-ray imaging, an immediate diagnosis can be given at the patient’s first visit. Most patients experience relief of symptoms with physical therapy treatment. However, in clinical practice, chronic wrist pain is more common. For its part, it is often difficult to make a definitive diagnosis, even with multiple consultations. If you know the complexity of the anatomy and biomechanics of the wrist joint, you will not be surprised by the above scenario. Within this small area of the wrist, there are many closely related structures, including more than 20 joints – the radial carpal, intercarpal, metacarpal, and distal radial ulnar joints, 26 carpal ligaments, and the triangular fibrocartilage complex (TFCC) – each of which may be the cause of an intra-articular injury or disease. In addition, there are 24 tendons, 2 major arteries and 6 nerves passing around the wrist joint, which constitute the source of extra-articular injuries. Arthroscopy allows direct visualization of the structures within the joint, making early diagnosis and treatment of wrist injuries possible. Wrist arthroscopy is one of the most effective tools for the diagnosis and treatment of radial carpal, midcarpal, and distal radial ulnar joint injuries. It can further improve the diagnostic information provided by imaging, and while directly examining the anatomical structures of the injury, it can also touch them with instruments (probes), providing accurate information on the site and extent of ligament injury, cartilage debridement, and synovitis, with the advantages of being less invasive, shorter recovery period, fewer comorbidities, and allows for immediate treatment. However, there are limitations to arthroscopy, including the fact that only intra-articular lesions can be examined. Therefore, diagnostic arthroscopy is indicated in cases where a thorough clinical examination suggests that the cause of the painful wrist symptoms is most likely intra-articular. A systematic approach to the diagnosis and treatment of the painful wrist is desirable. A comprehensive clinical evaluation of the painful wrist should include history taking, physical examination, and appropriate imaging. In the last decade, arthroscopy has become a valuable tool to help surgeons diagnose wrist injuries.