The stiff elbow is an unwanted but common dilemma encountered in most orthopedic surgeons’ practices. Proper assessment of the true etiology of the stiffness (congenital, post-traumatic, or arthritic) and the primary pathology (extrinsic or intrinsic) will help guide the proper treatment method. Traumatic injury to the elbow joint is the most common etiology of elbow stiffness. Capsular thickening, intra- and peri-articular adhesions, fracture displacement, arthrofibrosis, and heterotopic ossification all contribute to post-traumatic elbow stiffness. The most effective management of the stiff elbow is to avoid its occurrence. It is important to institute active motion with gentle passive assistance as soon as is practical after injury. Although non-operative management is always warranted, overly aggressive therapy and manipulation of the elbow can further exacerbate the original etiology and worsen the contracture. Pain and hemarthrosis play an integral role in the cascade of elbow stiffness. In the stiff elbow refractory to non-operative measures, surgical intervention may be warranted. Modern open techniques for stiff elbow release have fallen into two categories: the medial “over-the-top” approach popularized by Hotchkiss, and Morrey’s lateral “column procedure.” Increasingly, arthroscopic interventions as pioneered by Savoie and O’Driscoll are being used to achieve similar positive results while reducing the risk of recurrence and allowing early initiation of therapy.