Forty patients with thumb arthritis and carpal tunnel syndrome were randomized to receive a trapeziectomy procedure and carpal tunnel release performed with a single-incision (n=20) or two-incision approach (n=20). Outcomes of interest included pain on a Visual Analog Scale (VAS), the Boston Carpal Tunnel Questionnaire (BCTQ), the Quick Disability of the Arm, Shoulder and Hand (Quick-DASH) scores, grip strength, operative time and the incidence of adverse events. Outcomes were measured up to 3, 6 and 12 months post-operation. Results revealed no significant difference between the two groups in VAS pain scores, BCTQ scores, Quick-DASH scores, or grip strength at all time points. Operative time was significantly shorter with the single-incision approach, and the rate of pillar pain was significantly higher in the two-incision group compared to the single-incision group (4 v 0, p=0.035).