Swan neck and boutonniere deformities describe the two most common afflictions of the interphalangeal joints attributable to rheumatoid arthritis. Two separate classifications have been described, with an emphasis on practical treatment. The complications that can occur are very significant and the decision to perform reconstructive surgery in these patients must be made with full consideration of the patient's disease process, careful functional evaluation of the patient, specific adjacent joint involvement, and the overall treatment plan for improving the patient's function. The timing of hand, foot, and large joint surgery is complex and requires excellent communication among the patient and all the treating specialists, including the primary internist, rheumatologist, orthopaedic surgeon, and hand surgeon. The care for these patients is served best by a coordinated team approach.