Elbow stiffness severely hampers the activities of daily living. The condition can be determined by an articular deformity due to degenerative changes, as in primary arthrosis, or to injury and subsequent arthritic degeneration. Elbow stiffness is more frequent in younger patients with greater functional demands. Besides radiographic evaluation, a computed tomography scan is useful to gain insight into the complexity and extent of the bone lesions. Treatment depends on the patient’s symptoms, requirements, and expectations. The therapeutic options are numerous and range from arthroscopic to open techniques up to joint replacement. Total replacement should be considered as a salvage procedure and its indications are as important as the surgical technique.