Lateral epicondylitis is one of the most common disorder around the elbow. There is evidence that the degenerative process in lateral epicondylitis more selectively involves the origin of the extensor carpi radialis brevis as a result of overuse injury. The main US signs of lateral epicondylitis include a focal hypoechoic area on either a normal background or one characterized by a diffuse decrease in echotexture with loss of the fibrillar pattern. Focal hypoechoic areas, anechoic foci reflecting interstitial tears, calcifications, cortical irregularities and a hypervascular pattern at Doppler imaging correlate with clinical symptoms. The lateral ulnar collateral ligament may be injured in association with tears of the common extensor tendon as a result of the same forces or overuse mechanisms and an unsuspected tear of this ligament may be cause of conservative therapy failure. In case of coexisting tear of the lateral ulnar collateral ligament, a full-thickness defect of tendon fibers which reaches the radiocapitallar joint is found. In refractory cases that have failed to respond to physiotherapy and anti-inflammatory drugs, US can guide a dry needling procedure to treat painful tendinopathy. This technique consists of multiple passages with the needle in the tendon substance with or without intratendinous autologous blood or platelet-rich plasma supplement. On the medial aspect of the elbow, medial epicondylitis has the same histopathological picture as the more common lateral epicondylitis. This disorder derives from repetitive stress or overuse of the flexor-pronator musculature, most often affecting the pronator teres and the flexor carpi radialis. The US appearance of medial epicondylitis is similar to that of lateral epicondylitis. The main role of US is to distinguish the involvement of the tendon from a lesion of the underlying medial collateral ligament. Similar to the lateral epicondyle, enthesopathy may be observed at this site instead of tendinopathy.