Elbow arthroscopy has become a reliable and effective minimally invasive surgical technique that can be used for both diagnostic and therapeutic purposes across a wide range of indications, despite the inherently narrow anatomy of the joint. With advances in anatomical understanding and technological innovation, the procedure is now applied to various elbow disorders. In experienced hands, elbow arthroscopy allows stability assessment, lesion debridement, and microfracture techniques in cases of osteochondritis dissecans; selective excision of pathological extensor carpi radialis brevis fibers in lateral epicondylitis; arthroscopy-assisted repair and plication of the lateral and medial collateral ligament complexes in instability; osteophyte excision, capsulotomy, and synovectomy in osteoarthritis; and controlled release of arthrofibrotic tissues in the stiff elbow. Moreover, in selected coronoid, capitellar, and radial head fractures, direct intra-articular reduction and percutaneous fixation can be performed. The most prominent advantages of the technique include minimal soft-tissue disruption, the ability to address concomitant intra-articular pathologies during the same session, and the facilitation of rapid rehabilitation. This review provides a comprehensive overview of the indications for elbow arthroscopy, the fundamental principles of surgical techniques, and the clinical outcomes reported in the current literature.