Elbow mobility depends on bone and soft tissue health. Elbow stiffness is defined as the loss of movement greater than 30° in extension and loss of flexion of less than 120°. Both traumatic and atraumatic conditions can lead to the development of elbow stiffness. Intrinsic and extrinsic causes can be identified. Osteoarthritis (OA), rheumatoid arthritis (RA), psoriatic arthritis (PsA), gout, systemic lupus erythematosus (SLE), septic arthritis and hemophilia, heterotopic ossification, or post-burn contractures should be suspected, in the absence of a clear traumatic injury. Careful anamnesis and physical examination, together with radio-diagnostic imaging, help the physician towards the right diagnosis of the condition. Second-level imaging, computed tomography (CT) or magnetic resonance imaging (MRI), should be used for better surgical planning. Conservative treatment in these patients consists in rest, anti-inflammatory medications, and long-term modification of activity. Intra-articular steroid injections are not effective in the long term. Surgery is often the real solution for these patients and should be taken into consideration only after failure of conservative treatment and in case of great functional compromise. According to the primary cause of disease, surgical treatment can range from joint debridement to replacement arthroplasty in severe cases.