Frustrating design on the larger model at least.
I tried a lot of stuff before settling on a large trackball for most things. The thing that always bothered me is the middle wheel on the larger version of this. It feels relatively cheap and is poorly positioned for actual use. On an MX Master, the wheel is so much higher quality and the placement can be forgiven as you can back off your grip. The vertical mice, however, seem to be meant to be held in such a way that puts the wheel way up your finger, or not used at all.
MS makes some ergo stuff. They have a sculpt package... the mouse is ok, but i liked the keyboard a lot. It uses an annoying proprietary dongle, but ok. The keyboard had a key fail after about 8 months though and had to be scrapped. I bought another MS ergo model and it was horrible. ymmv.
I use an ugly very ergo keyboard now. I swap between pointing devices and use keyboard only as much as possible. For traditional mice I've found the deltahub carpio to be a nice add-on. For me, at least, it was a lot of testing until I found what worked for me.