Aim: To evaluate the therapeutic efficacy of ultrasound-guided injection of the transposed ulnar nerve at the elbow. Methods: Fifteen patients who underwent injection of a transposed ulnar nerve between 2014–2024 were identified. Sonographic appearances of the injected segment were scored using a Likert grading system for abnormality, and the cross-sectional area (mm²) was measured. Follow-up with respect to clinical response, need for subsequent therapeutic injection or decompressive surgery was recorded. Results: The grade of abnormality was mild (n = 4), moderate (n = 5), and severe (n = 3), with the remainder morphologically normal (n = 3). Inter-rater agreement was 0.91 (95% CI 0.80–1.00) with p <0.001. Crosssectional area ranged from 8–18 mm². Fourteen of fifteen patients (93%) experienced relief at the time of injection, decreasing to 12/15 (80%) at short-term follow-up <3 months, and further falling to 7/15 (47%) >3 months. Five patients (33%) underwent subsequent therapeutic injections, and three (20%) proceeded to revision surgery. There were no significant differences in grade between patients who experienced relief at any of the three time-points (p >0.05), nor differences in deformity or cross-sectional area between those who underwent subsequent injection (p >0.05) or surgery (p >0.05). Conclusion: Ultrasound-guided injection is a viable option for refractory neuropathic symptoms, although relief was often temporary, and 20% eventually required revision surgery.