Objective To analyze the ultrasonography of bone erosions (BE) in hands and wrists of the patients with rheumatoid arthritis (RA) and to evaluate the value of musculoskeletal ultrasound in the detection of BE. Methods Musculoskeletal ultrasonography of hands and wrists (including wrist, metacarpophalangeal and proximal interphalangeal joints) was performed in 76 patients with RA. Gray-scale ultrasonography, (GSUS) and power Doppler ultrasonography (PDUS) were used to detect synovitis, tenosynovitis and BE (according to the standards of 2010 EULAR OMERACT: defect of bone cortex is detected in both perpendicular sections of the longitudinal and short axes of lesion). The locations and amounts of BE were recorded. Ultrasonography of each joint lesion was semi-quantitatively graded and total scores were calculated. The relationships between BE and scores of synovitis and tenosynovitis were analyzed by SPSS 19.0. Results EB was detected in 49 cases among 76 patients with RA, with a total of 86 lesions. The number of BE was positively correlated with synovitis scores of both GSUS and PDUS (r = 0.579, P ＜ 0.01; r = 0.765, P ＜ 0.01). The GSUS score of BE was also positively correlated with synovitis scores of both GSUS and PDUS (r = 0.634, P ＜ 0.01; r = 0.828, P ＜ 0.01). There was no significant correlation between BE parameters and tenosynovitis scores (P ＞ 0.05). Conclusion Musculoskeletal ultrasonography can effectively detect BE lesions of hands and wrists in patients with RA. The development of BE is closely related to the severity of joint synovitis, especially the activity of inflammation.