We retrospectively reviewed our 34 first wrist dry arthroscopy cases using a single-use, 1.9 mm chip-on-tip system in wide-awake local anesthesia no tourniquet (WALANT). Thirteen patients were acute injuries; all acute patients underwent a magnetic resonance imaging (MRI) before arthroscopy. In total, 20 of 34 patients had a preoperative MRI. We use this method as a diagnostic tool in patients with wrist pain with suspected ligament tears and for the planning of treatment. We see 2 main advantages in the use of the needle chip-on-tip system: the simplicity of the procedure, and the minimal invasive character of the procedure due to the needle size that makes it possible to perform the procedure in WALANT. We find that the needle chip-on-tip arthroscopy system is a safe and cost-efficient alternative to wrist MRI with superior diagnostic ability. The procedure is minimally invasive and well suited for WALANT.