Lateral epicondylitis is the most common condition affecting the adult elbow. It occurs in middleaged individuals and is self-limiting in most cases. Based on clinical, histologic, and imaging data, the tendinous origin of the extensor carpi radialis brevis is the most likely site of pathology. When conservative measures fail, surgical management may be indicated. This can be accomplished by traditional open methods or by arthroscopic release. This article reviews the relevant anatomy of the common extensor tendon origin at the elbow and provides guidelines for surgical management of recalcitrant epicondylitis. Special emphasis is placed on arthroscopic techniques, which, when required, may allow for a more rapid return of the athlete to sport.