Athletes of all ages and skill levels commonly sustain injuries to their hands and wrists. Injured structures such as a displaced distal radius fracture sustained during a fall may be obvious. However, hand and wrist injuries often have a more nuanced presentation such as the vague palmar pain experienced with chronic hook of the hamate fractures seen in softball or baseball players. These injuries may stem from chronic low-impact repetitive activities or acute high-energy trauma. Therefore, to reach the correct diagnosis, which ultimately will help guide the treatment of hand and wrist injuries, it is important for the sports medicine physician to develop and use a systematic approach to the physical examination of the hand and wrist.