INTRODUCTION A Medial antibrachial cutaneous nerve sparing approach was used for ulnar nerve surgery at the elbow between January 1996 and December 1997. This safe posterior approach raises a medial flap that circumvents the olecranon around the lateral side and contains the posterior branches of the medial antibrachial cutaneous nerver in it. Injury to this nerve is prevented. MATERIAL & METHOD 50 submuscular ulnar nerve transpositions were done in a two year period metioned above. Telephone interviews were done on all fifty patients. Only 44/50 patients returned to the clinic for final follow-up evaluation of the following modalities: (1) sensation over the olecranon, (2) operative time, (3)wound complications, (4)range of motion of elbow, (5)grip strength, (6)return to previous employment. The average follow up was three years RESULTS There were three wound hematomas. The average operative time was 54 minutes. At six months after surgery the strength had returned to normal in 39/44 patients. At a year all had normal strength. The ROM was normal in all 44 patients. Five of the fifty patients did not return to their previous employment. CONCLUSION This medial antibrachial cutaneous nerve sparing approach to the ulnar nerve at the elbow, exposes the ulnar nerve quickly, safely, and avoid major complications in this very common ulnar nerve procedure.