Background: Elbow pain is a growing problem particularly among overhead athletes. Understanding the involved lesion is sometimes challenging problem because of anatomical complexity. So, precise diagnosis is a key to appropriate treatment and successful return to normal daily activities. Objective: This study aimed to emphasize the MRI role in detecting the tendinous, ligamentous, osseous, muscular, nerve and synovial based lesions in patients with elbow pain Subjects and methods: Our current retrospective study enrolled 60 patients complaining from elbow pain or discomfort in the period from January 2022 to August 2022. They were recruited from Orthopedic Surgery Outpatient Clinic and Radio-diagnosis Department, Zagazig University Hospitalsfor MRI evaluation. All patients were correlated with arthroscopic data as a gold standard. Results: Out of 60 patients, tendinous elbow lesions (flexor and extensor tendon injury) were the most frequent lesions (54/168, 32.1%), followed by ligamentous lesions (medial and lateral collateral ligament injuries) (40/168, 23.8 %), bony lesions (38/168, 22.6 %), muscle lesions (24/168, 14.3%) and nerve lesions were the least frequent (16/168, 9.6%). No significant difference between arthroscopy and MRI in detection of elbow pathology, with p value = 0.923169. MRI had 100% sensitivity for osseous lesions and excellent sensitivity in the diagnosis of tendon lesions (94.74%) as well as ligament lesions (90.91%). Also, it had good sensitivity in nerve lesions (76.19%). finally, MRI was highly specific tool with excellent accuracy in detecting all elbow pathologies. Conclusion: MRI has to be considered non-invasive precise diagnostic tool of elbow pain causes.