Surgical approaches to the elbow can be difficult in both acute and elective conditions. A sound understanding of neurovascular and ligamentous anatomy is essential for providing safe and effective access to the elbow joint. This review will present the four most common elbow approaches: lateral, posterior, medial, and anterior. For a successful procedure, the surgeon should have a comprehensive understanding of the elbow anatomy related to the selected approach, in addition to knowledge related to the appropriate treatment method for each disease and injury.