Brain-machine interface (BMI) is the latest solution to a lack of control for paralyzed or prosthetic limbs. In this paper the authors focus on the design of anatomical robotic hands that use BMI as a critical intervention in restorative neurosurgery and they justify the requirement for lower-level neuromusculoskeletal details (relating to biomechanics, muscles, peripheral nerves, and some aspects of the spinal cord) in both mechanical and control systems. A person uses his or her hands for intimate contact and dexterous interactions with objects that require the user to control not only the finger endpoint locations but also the forces and the stiffness of the fingers. To recreate all of these human properties in a robotic hand, the most direct and perhaps the optimal approach is to duplicate the anatomical musculoskeletal structure. When a prosthetic hand is anatomically correct, the input to the device can come from the same neural signals that used to arrive at the muscles in the original hand. The more similar the mechanical structure of a prosthetic hand is to a human hand, the less learning time is required for the user to recreate dexterous behavior. In addition, removing some of the nonlinearity from the relationship between the cortical signals and the finger movements into the peripheral controls and hardware vastly simplifies the needed BMI algorithms. (Nonlinearity refers to a system of equations in which effects are not proportional to their causes. Such a system could be difficult or impossible to model.) Finally, if a prosthetic hand can be built so that it is anatomically correct, subcomponents could be integrated back into remaining portions of the user's hand at any transitional locations. In the near future, anatomically correct prosthetic hands could be used in restorative neurosurgery to satisfy the user's needs for both aesthetics and ease of control while also providing the highest possible degree of dexterity.