Carpal tunnel syndrome (CTS) is said to be a condition of middle-aged women. Our experience is that it more commonly occurs in older people and also in a younger working population. The aim of this study is to describe the epidemiology of CTS requiring carpal tunnel decompression (CTD). Over a 10.5 year period 3073 CTD were performed on 2309 patients aged 15 – 93 years. This included all public, private and ACC funded cases in our region. During this period we had no restriction to access to CTD as all publicly funded cases were performed under local anaesthetic in a day surgery unit. Neurophysiological studies were performed pre-operatively by the same neurophysiologist. Population data from the national census (2006) was used to calculate the annual incidence of patients requiring CTD for each 5 year age band. There were 1418 females (61.4%) and 891 males (38.6 %). In contrast females comprised 116 of 306 (37.8%) patients who had their surgery funded by ACC. The mean age at surgery was 45 years for ACC cases compared with 56 years for non-ACC funded cases. The incidence of males having surgery funded by ACC was 1.7 times higher than females. There was a biphasic pattern in females with an incidence of 3.0/1000 at age 50–54 years, and a second higher peak of 3.1 to 3.4/1000 from 70 to 5 years. Males had a linear increase in incidence peaking at 3.1/1000 for age 65–69 years declining slightly to 2.8/1000 for age 70–85 years. The incidence was significantly higher in females than males overall (1.8 v 1.1/1000) and in patients under 65 years (1.4 v 0.8/1000). In patients over 65 years there was no significant difference in incidence (female 2.8, male 2.5/1000). Within our region, the incidence of surgically treated carpal tunnel syndrome increases with age. The highest rates are seen over the age of 70 in women and 65 years in men with no significant difference in rates between men or women over 65 years.