BACKGROUND The incidence of primary osteoarthritis of elbow is very low in individuals without work-related risk factors, and primary osteoarthritis of the elbow is rarely symptomatic. Because it is difficult to prove these conditions are work-related, the patients with work-related elbow osteoarthritis don't tend to be compensated in Korea. CASE REPORT: The patient was a 51-year old male, with an occupational history as a sledgehammer user for 23 years. He has been complaining of pain for 3 years. Physical examination of the elbow showed painful end-range motion and the radiographs showed osteophytes and, loose bodies, but relatively-preserved joint spaces, which were typical characteristic of primary osteoarthritis. CONCLUSION The authors report on a case of primary osteoarthritis of both elbows that was associated with repetitive high shear force due to long-term use of the sledgehammer.