To create the hand I placed an image of a hand onto a plane in the scene. Using a box converted to an editable poly I could now pull out the vertices to shape the hand.
To create the fingers I had to create new boxes and shape these by pulling out the vertices in line with the fingers on the image. For each finger I copied last finger and modified it as necessary to create new fingers.
Once all of the palm and fingers including thumb had been created I then had to remove selected polygons on the palm and at the end of the fingers. This would then allow me to be able to weld the fingers to the palm.
At this stage the hand appeared slightly flat and required shaping around the edges as it looked very square. This part of the process required me to move the vertices and place them in positions via freehand.
The hand was now beginning to look very realistic at this stage.
The easiest part was to create the arm. This was created by selecting the border of the opening of the palm and while holding the shift key I could now drag out the edge and create the arm, stopping and restarting to make stages in the arm such as the joints etc. By fine adjusting the vertices I could now shape the arm to give it more realistic shape.
A material could now be applied to the arm and hand. The selected material was an image of a skin texture.