For a long time, wrist arthroscopy has languished behind that of shoulder and elbow arthroscopy. However, over the past two decades, there has been a steady increase in therapeutic wrist procedures undertaken using the arthroscope. While diagnostic wrist arthroscopy is still a useful tool, its therapeutic advantages are starting to stack up against the risks of open wrist surgery – mainly stiffness. It remains a technically demanding procedure, but is clearly in the armamentarium of orthopedic hand and wrist surgeons. Recent advances of dry arthroscopy, arthroscopic reduction and internal fixation, and arthroscopic fusion procedures have changed the face of minimally invasive wrist surgery. The new NanoScope™ along with wide-awake, local anesthetic, and no tourniquet techniques, means that we now can dynamically assess and treat wrist pathology without even encountering the risk of anesthesia. Wrist surgery is evolving, and arthroscopy is right at the forefront.