Musculoskeletal ultrasonography (US) of the hands and wrist has recently been increasing in popularity. Recent rapid technical advances in the US, such as new ultra-high frequency probes and smaller probe sizes, have led to improved image quality. This, in turn, has accelerated the growth of musculoskeletal US. Known advantages of US are its lack of ionising radiation, noninvasiveness, portability and low cost. Dynamic and real-time assessment and Doppler imaging are additional benefits of this modality, especially in the imaging of the hands and wrist. Superficial structures of the hands and wrist, including the tendons, ligaments, nerves and vessels, are amenable to imaging with high frequency US. In this article, we demonstrate a spectrum of hand and wrist pathology using US, including entrapment neuropathy, inflammatory conditions, traumatic injury and masses. Ultrasound-guided procedures applicable to the hand and wrist are also briefly discussed.