Abstract Background: Ulnar nerve compression is a prevalent si-gnof neuropathy that involves the trapping of ulnar nerve of the upper extremities. The most effective surgical treatment for ulnar nerve compression is still a subject of debate. Aim of Study: This study aimed to evaluate the surgical outcomes of in situ ulnar nerve decompression versus transpo-sition as a treatment for compressive ulnar neuropathy. Patients and Methods: This randomized clinical trial was conducted on patients with compressive ulnar neuropathy, aged 18-60 years of both sexes. Patients were divided into two equal groups: Group A: Open in situ decompression; Group B: Sub-cutaneous transposition. Results: Visual analogue scale (VAS) and disabilities of the arm, shoulder, and hand (DASH) scoreswere significantly lower at 1y in group B than in group A (p=0.020 and 0.016 respectively). Motor conduction velocity (MCV) 1 and 2 scores were significantly higher at 1y in group B than in group A (p<0.05). Revision rate was significantly higher in group A by 4.5 times than group B (95% CI: 1.08-18.77) (p=0.037). Post-operative complications were insignificantly different among both groups. Conclusions: Subcutaneous transposition is more effi-cientthan in situ decompression in treating nerve compression syndrome as evidenced by notable reductions in pain, DASH scores, lower revision surgery rates, and increased motor con-duction velocities.