Arthroscopy of the elbow has evolved rapidly over the last decade into a powerful diagnostic and therapeutic tool. The value of elbow arthroscopy as a diagnostic tool lies in the surgeon’s ability to directly evaluate intraarticular structures that he or she can only indirectly evaluate with physical examination and radiographic studies. The diagnostic benefit of elbow arthroscopy is greatest in a patient who has a history of elbow pain or mechanical symptoms and has physical findings and radiographic studies documenting elbow abnormalities. However, by enabling the surgeon to document the absence of intraarticular abnormalities, diagnostic elbow arthroscopy benefits patients who have chronic pain and no physical findings or radiographic studies revealing intra-articular abnormalities. The proximity of vital neurovascular structures demands attention to the details of arthroscopy from the outset. Establishing a reproducible routine for performing a diagnostic arthroscopy minimizes the risk of complications and maximizes the benefit to the patient.