Agriculture is one of the most hazardous economic sectors, and it accounts for many accidents and occupational diseases every year. In Italy, about one-third of injuries involve the upper extremity, with long-term consequences for the workers and economic damage for agricultural companies and farms. This systematic review describes upper limb injuries among farmworkers, especially hand injuries, and highlights the main dangerous risk factors. Literature review included articles published in the major databases (PubMed, Cochrane Library, Scopus), using a combination of some relevant keywords. This online search yielded 951 references; after selection, the authors analyzed 53 articles (3 narrative reviews and 50 original articles). From this analysis, it appears that younger male farmers are mostly involved, especially in the harvesting season. The upper limb and hand are often the body parts that sustain most damage as these are mostly involved in driving tractors or tools. The most frequent type of lesions are open wounds, lacerations, fractures, strains, and overexertion lesions. Sometimes, a distracting element (such as mobile phone use, quarrels, working hours load) is present; poor use of protective devices and lack of safety design in tools can also increase the risk of accidents. For these reasons, in the agricultural sector, a system of health promotion and good practices is needed to promote workers’ awareness of the sources of risk, highlight more dangerous situations and apply organizational behavioral measures.