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Hand and wrist volar wounds are a common cause of emergency room (ER) visits. These wounds are explored surgically in the operating room at most hospitals. The main objective of our study was to prospectively assess the correlation between clinical examination in the ER performed by a surgical resident and the tendon, vascular and/or nerve damage found during surgery in hand and wrist volar wounds. The second objective was to describe the lesions based on their mechanism, as well as their topography. Eighty patients from two hand surgery referral centers were included. Patients’ past medical history was obtained, as well as records of their physical examination in the ER and description of lesions found during surgery. In 28% of wounds with a normal clinical examination, tendon, vascular or nerve damage was found on surgical exploration. Out of the cases that tested negative for tendon injury in the ER, 16% had partial tendon injury or digital tunnel wound discovered during surgery. Nerve damage was found during surgery in 12% of cases that had not been detected clinically preoperatively. Based on our findings, we recommend performing surgical exploration for all volar hand and wrist wounds in the operating room, as physical examination does not detect all tendons, vascular or nerve injuries.