Objective & Background: Hand injuries are one of the commonest injuries seen in Accident and Emergency department and effect mostly the people of working age group. Glass injuries account for around 40% of missed injuries in hand and wrist. Thus accurate diagnosis and subsequent management of such injuries is important in order to avoid morbidity, time off work and financial impact on the community. This study investigates the diagnostic accuracy of pre operative examination of glass laceration to hand and wrist undergoing surgical exploration. Methods: Between July 2007 to October 2008, 44 consecutive patients with 58 lacerations presenting with glass injury to hand and wrist within 24 hours of injury were included in this prospective study. Results: Intra operatively, arteries were found lacerated 21 times however pre operative examination could detect injury only 14 times. Similarly, 33 nerves were found injured intra operatively while preoperative examination was able to detect only 27. Intra operatively, 158 tendons were found lacerated. Preoperative examination could detect injury to 107 tendons. This difference was statistically significant for arteries, nerves and tendons with p value less than 0.001 for each of them. Conclusion: Incidence of missed injuries in glass lacerations to hand and wrist is high. Although clinical examination gives an idea of what structures are injured, it significantly underestimates the true extent of injury. Hence, formal exploration should be considered when glass is implicated as a cause of injury.