Twenty-one patients underwent arthroscopic treatment for posterior impingement associated with degenerative elbow arthritis. Anterior debridement and removal of loose bodies was performed first. The posterior procedure consisted of three parts: removal of posterior loose bodies, removal of the posterior olecranon osteophyte, and removal of the osteophytes in the olecranon fossa to the point of fenestration. Patients were assessed for pain, strength, motion, stability, and function. They were classified as excellent, good, fair, or poor. Twenty-one of 25 patients were followed an average of 35 months. There was a statistically significant improvement in all criteria. There were 10 good and 11 fair ratings preoperatively; this improved to 14 excellent and 7 good results postoperatively (P = .0001). Arthroscopic treatment for posterior impingement in the degenerative elbow offers substantial improvement with minimal risk, provided proper intraoperative precautions are followed.