But up against Spaniard Ramos-Vinolas, the 29-year-old looked some way short of his best form as he suffered a 2-6 6-2 7-5 defeat.
He managed to take six consecutive points to re-establish the lead but he was powerless from stopping the resurgent Ramos-Vinolas from sealing the next three games to secure a quarter-final berth against fifth-seed Marin Cilic.
At times, Murray, one of the sport's speediest players and best hustlers, did not run for a few shots suggesting he wasn't completely physically fit.
Murray showed trademark fight in fending off three break points at 4-4 in the decider, but could not respond when the Spaniard was in the ascendancy in his next service game. Cuevas hit a sweet forehand victor down the line on the next point and raised his arms after beating Wawrinka in their first-ever meeting.
Murray endured another lengthy opening service game at the beginning of the second set to nudge 1-0 up before Ramos-Vinolas held for the first time in the match to level the scores and kickstart his revival.
Andy Murray's first tournament back on clay came to an ignominious end when he let slip a 4-0 lead in the decider to lose to world number 24 Albert Ramos-Vinolas. The Croatian reached the last eight after beating No. 9 Tomas Berdych 6-2, 7-6 (0).
The Spanish claycourt specialist won four games in a row, before Murray applied some late pressure, and was implacable as he won the next two with back-to-back breaks and served for the match.
'My elbow felt pretty good. It got better each day.
If I'd been offered this result a week, 10 days ago, I would've taken it " I didn't know if I was going to be able to play here or not.
"I don't hit the ball as hard as a lot of the guys".
Swiss third seed Stan Wawrinka, the 2015 French Open champion, was also sent packing when he lost to Uruguay's Pablo Cuevas 4-6, 4-6.
Spain's Rafael Nadal reacts after defeating Germany's Alexander Zverev during their third round match of the Monte Carlo Tennis Masters in Monaco, Thursday April 20, 2017.
Goffin downed No. 6 Dominic Thiem of Austria 7-6 (4), 4-6, 6-3, and No. 11 Lucas Pouille of France was 3-0 up when countryman Adrian Mannarino retired with a hip problem.