Recent synthetic 3D human datasets for the face, body, and hands have pushed the limits on photorealism. Face recognition and body pose estimation have achieved state-of-the-art performance using synthetic training data alone, but for the hand, there is still a large synthetic-to-real gap. This paper presents the first systematic study of the synthetic-to-real gap of 3D hand pose estimation. We analyze the gap and identify key components such as the forearm, image frequency statistics, hand pose, and object occlusions. To facilitate our analysis, we propose a data synthesis pipeline to synthesize high-quality data. We demonstrate that synthetic hand data can achieve the same level of accuracy as real data when integrating our identified components, paving the path to use synthetic data alone for hand pose estimation. Source code and data will be released upon acceptance.