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Study Design: This is a cross-sectional descriptive study., Objectives: To quantify differences in hand muscle morphology between persons with cervical spinal cord injury (SCI) and uninjured adults., Setting: The study was performed at the Guangdong Work Injury Rehabilitation Hospital., Methods: We quantified hand muscle cross-sectional area (CSA), thickness, and echo intensity (EI) in 18 persons with subacute to chronic SCI and 23 controls using ultrasound imaging., Results: Mean SCI abductor pollicis brevis (APB), abductor digiti minimi (ADM), and first dorsal interosseous (FDI) CSA were ~26%, 43%, and 37% smaller than the control means, the deficit in the APB being less than the ADM (P < 0.05). Muscle thickness was also smaller after SCI, but deficits in ADM (31%) and FDI (20%) thickness were less than the CSA deficits (P < 0.05). In five SCI persons, APB CSA and/or opponens pollicis (OP) thickness were normal despite complete motor paralysis. Mean longitudinal image EI was 40% higher in the OP and 15% higher in the flexor pollicis brevis (FPB) after SCI (P < 0.05), suggesting denervation-induced infiltration of fat and fibrous tissues. OP EI was related to OP thickness (r = -0.6, P = 0.007, n = 18). Mean axial image EI was 10% higher in the APB and ADM after SCI (P < 0.05). There were no significant correlations between muscle morphological properties and clinical features in the SCI participants., Conclusion: Our results indicate significant SCI atrophy and elevated EI that are muscle dependent., (© 2021. The Author(s), under exclusive licence to International Spinal Cord Society.)