The elbow is frequently affected by congenital differences that limit flexion–extension and supination–pronation. The limitation can occur in utero or develop over time. Delayed causes usually gradually disrupt the anatomy and function of the paired bone forearm. Accurate diagnosis is based on a careful examination and perusal of radiographs. Certain diagnoses can be helped by surgery and will result in improved limb usage and function. In contrast, other diagnoses are recalcitrant to modern operative techniques but will benefit from occupational therapy and adaptive equipment to enhance independence and activities essential to daily life. This article discusses diagnosis and treatment of synostosis, arthrogryposis, pterygium, multiple hereditary exostosis, and the unsalvageable forearm.