The aim of this study was to examine the association of occupation and gender with the incidence and severity of carpal tunnel syndrome (CTS). We examined 884 patients of working age, diagnosed with CTS, in a specialist hand clinic that was the only provider of hand services to a health board area. We categorized occupation using the Standard Occupational Classification 2010 (SOC2010) and used local census data to calculate the incidence in each of the nine major occupational groups. The greatest incidence was in caring and leisure occupations (197 per 100 000 population per year), while the lowest incidence was in the associate professional group (37 per 100 000). Professional occupations had a high incidence of CTS, along with skilled trades and elementary occupations. Women had a higher incidence of CTS than men in managerial, professional, skilled trades, and elementary occupations (OR 2.9-3.6). The Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score varied across occupational groups (p < 0.001) and was worst in the caring and leisure group. As traditional heavy industry associated with previously described occupational risks declines, new patterns of occupational association may emerge. We recommend ongoing observational research of potential occupational risk factors to identify these new trends.