Non-traumatic hand and wrist avascular necrosis are mostly idiopathic. Among the causes that can be detected are conditions such as alcoholism and steroid use, procoagulant causes leading to intraluminal obliteration, microscopic embolism, as well as cytotoxicity and genetic factors. Avascular necrosis of the hand and wrist is an important cause of pain, limited motion and weakness in this area. Although there is no absolute correlation between the clinical and radiological findings of the disease, imaging methods can be a guide in staging the diseases. In the choice of treatment, many factors such as the cause of the disease, the region, stage, age of the patient are taken into consideration and evaluated in a wide spectrum ranging from conservative treatment to vascularized bone grafts.