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A design problem that is not obvious from the picture, and which is not a general problem of vertical mice, but of this mouse: Unlike a "proper" vertical mouse, it does not have sufficient handrest or thumbrest. The shape, however, does not even allow use when the pinky edge is placed on the table - the buttons are too high and the non-functional support of the pinky edge bumps into the hand. The hand cannot be released with this mouse. After half an hour, cramp in palm/thumb, carpal pain and arm pain. I've never met such a bad mouse before. I think that even the cheapest mouse, if at least 80% "fit", is much healthier than this mouse. I bought the Microsoft Sculpt Ergonomic Mouse instead of the broken one, but I'm returning it and will probably end up buying the expensive semi-vertical Microsoft Sculpt Ergonomic Mouse again.