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Cubital tunnel syndrome is common, but not fully understood. Fortunately, most cases of ulnar nerve compression improve with nonsurgical treatment and large majority get better with surgical decompression. The fact that most people get better with and without surgical treatment is likely the reason that multiple studies have failed to show improved results with different types of decompressions for mild cubital tunnel syndrome. Transposition surgeries have been shown to yield better results with more severe cases and patients who failed previous simple releases, likely secondary to release of other compression sites that were missed by the initial surgery. Knowing more about pathology of the cutbital tunnel syndrome such as compression versus traction injury and having better modalities for evaluation of the nerve should help us to better tailor treatment for the patients in the future.