Brief Answer:
Multiple possibilities, need work up & Management

Detailed Answer:
Thank you for asking!
One upper extremity getting swollen and painful with no recent history of trauma or infusion or IV abuse make it worth examination as may possibilities can cause this. It is a mixed presentation of vascular neurological and pain associated entities and it needs some work up with a visit to a neurologist and getting some cervical spine films done with axillary films to assess any nerve compression or brachial plexus neuropathy. ALcohol intake may make a possibility of a neurovascular structures entrapment more likely.
If there has been any trauma or recent Intra venous administration of some medicine or illicit drugs which needle marks will confirm, then suspicion of thrombophlebitis will be more likely as that present the very same way.
Getting doppler studies for the vascular structure of the arm and electromyographic and nerve conduction studies of the extremities are also advised to see what is causing this. It could be a thoracic out let syndrome which is very common in young age females and is classically presented this way too. Cervical spondylosis i.e compression of cervical spines to entrap nerves arising from it may also cause that. It can be some artery infections like Polyarteritis nodosa as she had a past history of renal stones and that leads the odds for vasculitis infections like PAN more likely. Smoking itself is a damage to epithelium of vessels and that may also be the reason for this vasculitic thrombophlebitic etiology.
ANy how there are many possibilities and it needs a little work up and complete examination and detailed history to narrow the diagnosis and connect the dots to get to a final diagnosis. Something is wrong with the vasculature and it needs to be sorted out. Get to an endovascular surgeon and a neurologist and let them take the matter further for better and complete management.
I hope it helps. Take her to the hospital and take good care of her. Don't forget to close the discussion please.
Regards
S Khan

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Brief Answer:
Venous etiology, return compromised

Detailed Answer:
Thank you for getting back to me!
If bringing the arm up subsides the symptoms , then it is mostly in the venous return problems as gravity assists the return by arm lifting. It needs a vascular specialist and let us hope for the best. Doppler sonographies will sort it out.
Be optimistic and take good care.Don't forget to close the discussion please.
Regards
S Khan

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Brief Answer:
No worries

Detailed Answer:
Thank you for asking!
It was just an optimistic gesture. Nothing serious. It will be innocuous. It has been here for a year. I am sure it won't be anything troublesome and just needs a little work up to sort out all the possibilities i mentioned in my first response.
Hoping for the best is what we always do, this optimism keeps our energies and spirits boosted.
I hope it clears things up.Take care.
S Khan

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