Lateral epicondylitis is a frequent musculoskeletal condition characterized by pain and tenderness over the lateral elbow, primarily involving degenerative tendinopathy of the extensor carpi radialis brevis tendon. Despite its inflammatory misnomer, lateral epicondylitis represents a non-inflammatory angiofibroblastic degeneration caused by repetitive mechanical overload. The condition affects 1–3% of adults annually, peaking between 35 and 60 years of age, and is frequently associated with occupational and recreational overuse rather than sports participation. Anatomically, the lateral epicondyle serves as the origin of multiple extensor tendons and the lateral collateral ligament complex, both critical to elbow stability. Biomechanically, repetitive eccentric stress, compounded by poor vascularization and potential lateral ligamentous laxity, drives tendon degeneration and chronic pain. Diagnosis is primarily clinical, supported by imaging modalities such as ultrasound and magnetic resonance imaging for complex or refractory cases. Differential diagnoses include osteochondritis dissecans, nerve entrapment syndromes, posterolateral rotatory instability, and plica syndrome. Preventive strategies emphasize ergonomic modifications, load management, and strengthening of the forearm and shoulder stabilizers. Lateral epicondylitis is often a self-limiting condition that resolves within 12–18 months without intervention. Conservative management remains the mainstay, incorporating activity modification, physiotherapy, orthotic support, and possibly injective therapies, though high-quality evidence shows no clear superiority over placebo. Surgical intervention, including open, percutaneous, and arthroscopic debridement, is reserved for recalcitrant cases unresponsive to prolonged nonoperative care. Arthroscopy allows simultaneous evaluation of intra-articular pathology and restoration of joint stability. Outcomes for both conservative and surgical treatments are generally favorable, with most patients achieving symptom resolution. Nevertheless, recurrence and persistent pain highlight the multifactorial etiology and the need for individualized, pathology-based management approaches.