Background: Elbow pain is a common presenting symptom in repetitive motion performing athletes. Due to the popular use of prolonged conservative therapy in elbow pain, and the importance of early surgical intervention in Elbow Synovial Fold Syndrome, proper and prompt diagnosis is essential. In our case report, a 16 year old male right hand-dominant baseball pitcher presents with gradual onset of posterolateral right elbow pain over 4 months. Purpose: This study helps reflect the correct timeline in imaging along with the appropriate duration of conservative management. After reviewing this study the reader will be better able to differentiate between Lateral Epicondylitis and ESFS reducing the incidence of missed diagnosis and irreversible injury. It also exhibits the positive outcome of surgical intervention following the failure of conservative therapy. Methods: A comprehensive literature search was performed on the internet including textbooks and journals on the topic of Elbow Synovial Fold Syndrome and elbow pain. Information was scarce and we were unable to find any meta-analysis studies on the condition indicating the opportunity for further research in this topic. Pertinent information was included on our retrospective case report. Results: High-definition ultrasound in conjunction with MR arthroscopic examination of the joint in conjunction will provide a definitive diagnosis of ESFS in a patient presenting with persistent elbow pain. First line treatment is conservative therapy for a period of 8 weeks to no greater than 6 months. At this point arthroscopic excision of the pathologic plica is performed to avoid irreversible articular cartilage degeneration. Outcomes after arthroscopic resection, focal fibrosis, and repair of chondral defects are excellent Conclusion: Elbow synovial fold syndrome can be found in athletes, especially those in sports that require repetitive motion of the elbow. It can be easily misdiagnosed. As in our case, even an MRI may show negative findings early on. CT or MR arthrography, along with dynamic US, are helpful in diagnosing ESFS and considered superior to MRI in this specific instance. A short course of conservative therapy is appropriate, however, If conservative therapy fails, then prompt arthroscopic excision is appropriate. As was noted in our literature search, cases on ESFS are lacking and the topic would benefit from retrospective data collection over large populations and a broad time period.