Hand dexterity is crucial for humans to interactions with the external environment. Many activities of daily living (ADLs) such as pressing, grasping, writing and typing would be unattainable without a skillfully and proficiently functioning hand. Sexagenarians and older often experience difficulties in hand dexterity, which seriously impair their ability to perform ADLs. This study described the aging-related changes in hand muscle size and dexterity; and addressed the conflicting literature regarding the extent of atrophy to either the intrinsic or extrinsic hand muscles in the elderly. The overall hypotheses for this study were 1) that elderly adults show an aging-related decrease in hand muscle size and strength, especially a greater decrease in the intrinsic hand muscles, 2) elderly adults show an aging-related decrease in hand dexterity and 3) hand muscle size and strength are positively related to hand dexterity. This study examined hand muscle sizes with magnetic resonance imaging (MRI) and examined hand strength and other functional measures. This study found aging-related decreases in muscle size, muscle strength, hand dexterity. Furthermore, intrinsic muscles showed a greater aging-related decrease in volume and strength as compared to the extrinsic muscles. When examining relationships, muscle strength was positively correlated to multi-finger synergy and finger dependence. Also, muscle size was positively related to performance on clinical hand dexterity tests. This supports the strength-dexterity equivalence hypothesis.