The study aimed to determine the risk factors for incident carpal tunnel syndrome (CTS) in a large working population, with a special focus on factors related to work organization. In 2002 2005, 3710 workers were assessed and, in 2007 2010, 1611 were re-examined. At baseline all completed a self-administered questionnaire about personal/medical factors and work exposure. CTS symptoms and physical examination signs were assessed by a standardized medical examination at baseline and follow-up. The risk of "symptomatic CTS" was higher for women (OR = 2.9 [1.7 5.2]) and increased linearly with age (OR = 1.04 [1.00 1.07] for 1-year increment). Two work organizational factors remained in the multivariate risk model after adjustment for the personal/medical and biomechanical factors: payment on a piecework basis (OR = 2.0, 95% CI 1.1 3.5) and work pace dependent on automatic rate (OR = 1.9, 95% CI 0.9 4.1). Several factors related to work organization were associated with incident CTS after adjustment for potential confounders.