Brown the beef & aromatics - Melt butter in a large skillet over medium heat. Add ground beef, onions, and garlic. Cook until beef is no longer pink and onions are soft.
Season the mixture - Sprinkle in paprika, salt, and black pepper. Stir to evenly coat the beef and onions.
Make the roux - Add the flour and stir well for 1-2 minutes to form a light roux that will naturally thicken the sauce.
Add liquids - Pour in beef broth and Worcestershire sauce, scraping the bottom of the pan to deglaze and lift all the flavor.
Cook pasta - Stir in the uncooked elbow macaroni. Reduce heat to a gentle simmer, cover, and cook until pasta is tender and most of the liquid is absorbed (about 12-15 minutes).
Add creaminess - Remove from heat and stir in sour cream until the sauce is silky and smooth.
Adjust seasoning - Taste and add extra salt, pepper, or Worcestershire sauce if desired.
Serve - Garnish with chopped parsley, paprika, or shredded cheese. Serve hot with your favorite sides.