 Ulnar nerve compression at the elbow is a common problem and can significantly affect hand function in severe cases. The current, standard treatment is Ulnar nerve decompression with or without transposition moving the ulnar nerve to a site where there is less compression. In severe compression, the clinical results after this surgery are typically poor. Distal transfers of functioning nerves at the level of the wrist to the compressed ulnar nerve anterior interosseous nerve to ulnar motor fascicles have been suggested to supercharge or augment hand muscles while nerve axons regenerate from the level of the elbow after decompressiontransposition. In fact, this treatment is becoming widely adopted without clear evidence that it changes outcomes. The investigators propose to prospectively compare the effectiveness of ulnar nerve decompressiontransposition versus decompressiontransposition and distal nerve transfer. 