Originally populated by British loyalists fleeing the newly independent United States of America in 1785, it has survived on fishing, boat building, and salvage.

Its main village of Hope Town surrounds a protected harbor with a noted red-and-white-striped one-hundred-and-twenty-foot-tall (37-metre) lighthouse built in 1863.

On September 1, 2019, Elbow Cay took a direct hit from Category 5 Hurricane Dorian, with sustained winds of 185 mph (295 km/h).

Elbow Cay is located about 4 miles (6.4 kilometres) east of Marsh Harbour on Great Abaco Island.

Further south, there are more residences and rental properties spread out along the roads to the narrow part of the island near White Sound.

[6] The episodes "My Soul on Fire" (Part 1 and 2) of the TV series Scrubs were filmed on the island for the Janitor and Lady's wedding.