Raising ones arm in the air for years on end is not good for the circulation. Check out the fingernails. Visit the main gallery for further explanation: http://ericjohnsonvik.smugmug.com/India/Kumhb-Mela/Sadhu-Camp/11131992_JKgSt#780050745_zYnqM

This sadhu may have held his arm in the air for years if not decades. Smoking ganja might help with the pain.