We describe an unusual case of osteoid osteoma of the radial head that was treated by means of elbow arthroscopy. A 42-year-old man presented with a history of elbow pain lasting for 2 years that progressed after an unsuccessful previous operative procedure. Computed tomography and bone scan evaluation revealed the possibility of an osteoid osteoma of the radial head. Elbow arthroscopy under image intensifier guidance was completed to locate and remove the lesion. The shavings were collected, and a histologic analysis was performed, the findings of which were consistent with the preoperative diagnosis. An immediate decline in pain with an excellent and lasting increase in function was observed postoperatively. Radical open surgery is curative for osteoid osteoma and also allows for an excellent histologic confirmation of the diagnosis in the setting of a juxta-articular osteoid osteoma, but the residual morbidity does not justify it around accessible joint locations in this self-limited, albeit painful, disease. Thought should be given to the possibility of arthroscopic retrieval or excision with minimal operative damage before proceeding with open surgery. The use of a motorized instrument for excision does not preclude pathologic evaluation of the specimens.