With adequate equipment, training, and expertise, ultrasound (US) should be regarded as the first-line imaging modality for the assessment of a wide range of pathological conditions affecting the soft tissues around the wrist and hand. With high-resolution transducers, US allows detection of foreign bodies and a reliable identification of a variety of traumatic lesions affecting tendons, retinacula and annular pulleys, ligaments, vessels, and nerves. In addition, inflammatory arthropathies, infectious disorders, overuse tendinopathies, and degenerative conditions can be diagnosed with this technique. In the wrist, US is able to identify the entrapment of the median, ulnar, and radial nerves. In patients with localized soft tissue swelling, US is able to assess the presence of a space-occupying lesion and to characterize its nature in many cases.