Cubital tunnel syndrome may manifest along a clinical spectrum from mild, annoying paresthesias and pain in the ring and small fingers to atrophy of the intrinsic hand musculature, loss of two‐point discrimination, and significant hand dysfunction. Accurate diagnosis best derives from a thorough history and physical examination. Electrodiagnostic studies play a primarily corroborative role and are often negative during the early stages of ulnar neuropathy. The anatomic course of the ulnar nerve through the upper limb must be fully understood, especially if conservative treatment fails and surgery becomes necessary. Operative treatment is designed to decompress the nerve fully and to protect it from future compression. Although medial epicondylectomy is favored by some, the potential for medial collateral ligament injury remains a concern. Anterior transposition of the ulnar nerve is popular, and surgeon preference and training probably play the largest role in determining whether to place the nerve subcutaneously, intramuscularly, or submuscularly. Good clinical outcomes can be expected with each of these procedures, except for those patients with advanced neuropathy.