The evaluation, classification, and treatment of carpal instability continues to be one of the most controversial topics in hand surgery. One explanation is the lack of standardized findings and radiographic criteria. No good modality to date has been proposed to accurately aid in evaluating carpal instability. Wrist arthroscopy has become increasingly useful in the assessment of mechanical wrist pain. With this technology, specific patterns of injury can more accurately be identified by direct visualization. This will also aid in implementing a reproducible, less subjective means of describing wrist instability. The treatment can then be focused on management of the specific ligamentous injury responsible for the pattern of instability visualized. The following is an attempt to categorize these instability patterns as seen through arthroscopy and provide our proposed treatment options.