Introduction: Primary osteoarthritis(OA) of the elbow is a rare condition, characterized by painful stiffness, mechanical symptoms, and the presence of hypertrophic osteophytes. Elbow osteoarthritis typically affects middle-aged men who engage in strenuous manual activity. We hereby present a case of bilateral primary elbow osteoarthritis and discuss its various treatment options. Case report:A 45 years old male patient presented to outpatient department with complaints of pain in both elbows since one year. There was no history of previous trauma or other complaints pertaining to elbow. He was a manual laborer working in farms. He had tenderness on deep palpation of elbow. All movements at elbow (extension, flexion, supination and pronation) were terminally restricted. X-rays of both elbows revealed osteoarthritis of elbow. After thorough discussion of treatment options with patient, he opted for non-operative management. Key massage: It requires a high index of suspicion to diagnose primary OA of elbow. Best treatment optioninvolves capsular release and removal of impinging osteophytes but non-operative treatment remains the first step in the early management of elbow osteoarthritis.