Case Report: A 36-year-old female presented with a 12-month history of worsening pain and paraesthesia in her right hand. Examination revealed a firm mass and positive Tinel’s sign in her cubital tunnel along with sensory alteration of ring and little fingers, but no motor weakness. Ultrasound and MRI showed an encapsulated heterogeneous lesion overlying the ulnar nerve. To rule out malignancy, an US-guided biopsy confirmed angioleiomyoma before undertaking definitive surgery. Intraoperatively, a firm mass adherent to Osborne's ligament distally was found compressing the ulnar nerve. In-situ nerve decompression was performed, and the mass removed. Immediate follow-up revealed improved pain, with ongoing assessments and hand therapy scheduled to initiate nerve glide exercises and sensory symptom resolution monitoring. Purpose: This case highlights the importance of considering space-occupying lesions as a rare cause of ulnar nerve compression around the cubital tunnel. Discussion: Angioleiomyoma are benign soft tissue tumours. They typically present as large, often painful, subcutaneous masses. There is limited literature on angioleiomyoma occurring within spaces like the cubital and carpal tunnels, causing nerve compression. In such cases, thorough investigation for an accurate diagnosis and surgical planning, including potential nerve sacrifice and reconstruction, is crucial. Conclusion: This case raises awareness of less common causes of cubital tunnel syndrome. Adequate investigation is essential to exclude more serious pathology and enable proper surgical planning. Timely management with identification of the nerve, neurolysis and mass excision can lead to rapid symptom improvement and enhanced quality of life.