Background Hand and wrist injuries are one of the most common injuries seen in adults. The Patient-Rated Wrist Evaluation (PRWE) questionnaire has been developed as a patient-report outcome measure of pain and disability to evaluate the outcome after hand and wrist injuries. Objective The aims of this study were (1) to evaluate the structural validity of the existing Dutch version of the PRWE (PRWE-NL) in patients with hand or wrist injuries and (2) to investigate the appropriateness of reporting subscale scores. Design This was a retrospective analysis of cross-sectional data of 368 adult patients. Methods Patients aged 18 to 65 years and treated either surgically or conservatively for an isolated hand or wrist injury were recruited. Patients were excluded if they were unable to speak or read Dutch. Confirmatory factor analyses were used to investigate structural validity, and Cronbach alpha (α) and omega (ω) coefficients were used to investigate internal consistency. Results A series of confirmatory factor analyses revealed that all models (ie, a single-factor model, correlated 2- and 3-factor models, and 2 bifactor models) were associated with adequate model fit. However, inspection of the factor loadings, the explained common variance (ECV), and the different coefficient omega values revealed that the PRWE-NL should be considered a measure of a unidimensional trait. In addition, PRWE-NL subscales were associated with unacceptably low levels of reliability independently of the global PRWE-NL factor. Limitations Although the sample size was adequate, the response rate was 37.1%. Participants were mainly patients with fractures of the wrist or hand, predominantly treated nonsurgically. Conclusion This study suggests that the PRWE-NL measures a unidimensional trait. A single score should be used for the PRWE-NL, without subscale scores.