The authors report 235 cases of ulnar neuropathy at the elbow. The treatment was simple decompression in 115 cases and anterior transposition in 120 cases. Men were affected 3 times as often as women. The average age of presentation was 54.5 years. The nondominant arm was involved more frequently. The etiology of ulnar neuropathy was diverse, but one-third of the cases fell into the idiopathic category. Numbness and paresthesia were the most common complaints. Examination revealed hypalgesia of the little finger and the medial half of the ring finger, with weakness and wasting of the intrinsic muscles of the hand. Electromyography and nerve conduction studies are important for early diagnosis. Young men with a symptom duration of 1 year or less have a better chance of improvement after the operation. Both simple decompression and anterior transposition result in improvement in 82% of the cases; however, a higher percentage of full recovery was seen in the cases treated by simple decompression. This is explained by the facts that the nerve is not handled and its vital blood supply is left intact.