Cubital tunnel syndrome is a common but complicated ulnar neuropathy that needs to be carefully evaluated and classified before developing a cohesive plan of attack. In situ decompression/with medial epicondylectomy (ISD/ME) can be a viable treatment option for all preoperative grades of cubital tunnel syndrome, but may not necessarily be the treatment of choice, based on information gathered from the patient's preoperative evaluation. We outline a comprehensive list of indications for treatment of cubital tunnel syndrome by ISD/ME. If one adheres to these indications, and abides by the technique of a partial medial epicondylar excision, as advocated by O'Driscoll, Amako, and others, the results indicate that patients should have an acceptable outcome.