Correct diagnosis of wrist injuries is critical in preventing prolonged pain and dysfunction. Radiographs cannot diagnose a large percentage of injuries. Wrist sprain is considered one of the most common yet most treacherous emergency department (ED) diagnoses because radiographs do not always rule out all acute injuries. Knowledge of the anatomy, normal physical examination findings, and physical examination abnormalities associated with different pathological conditions, is paramount in making the correct diagnosis. This article focuses on the anatomy, diagnosis, and ED management of acute wrist injuries, including fractures and dislocations.