Is a vertical mouse better for your wrist?

A vertical mouse is better at one thing that has been measured clearly: it turns your hand onto its side, so your forearm twists less than on a flat mouse and the muscles on the back of the forearm work a little less. Whether that prevents wrist pain or carpal tunnel syndrome is far less certain. The trials are few and small, and in people who already had carpal tunnel syndrome a vertical mouse did not lower the pressure on the nerve. It is a reasonable thing to try if a standard mouse bothers you. It is not a treatment.

What does a vertical mouse change?

On a standard mouse your palm faces the desk. To get it there, the forearm rotates inwards, a movement called pronation. A vertical mouse is shaped so that you grip it with your hand on its side, closer to a handshake, which needs less of that rotation.

The difference shows up when people are measured. In a lab study of 16 people, forearm pronation averaged 28 degrees on a vertical mouse against 42 degrees on a standard one. Activity in two extensor muscles on the back of the forearm was also a little lower: 13% against 16%, and 10% against 13% (Quemelo & Vieira, 2013).

An older study found the same pattern in 19 experienced computer workers doing a text-editing task. With the hand in a neutral, upright position, muscle activity in the forearm extensors and in a small muscle of the hand was lower than with the hand flat (Gustafsson & Hagberg, 2003).

These are differences in posture and muscle effort over minutes in a lab. They fit the basic idea of ergonomics, reducing strain, but they do not show that fewer people end up with sore wrists.

How you hold it matters as much as the shape

In a study of 30 adults, an alternative mouse design reduced forearm pronation by up to 11.5 degrees compared with a standard mouse, and pronation fell further when people were shown how to hold it. Lower wrist extensor activity appeared only after people got those instructions (Houwink et al., 2009). A new shape does not do all the work by itself.

Is a vertical mouse better for carpal tunnel syndrome?

Carpal tunnel syndrome is pressure on the median nerve where it passes through the wrist. The NHS lists an ache or pain in the fingers, hand or arm, numb hands, tingling or pins and needles, and a weak thumb or difficulty gripping, often worse at night (NHS).

Does using a mouse cause it?

Less clearly than many people assume. A Danish study followed 6,943 trade union members for a year. Using a mouse for more than 20 hours a week was linked to a higher risk of possible carpal tunnel syndrome, while keyboard use was not. But the condition was uncommon: tingling or numbness in the nerve’s area of the right hand, confirmed by interview, was found in 4.8% of people. The authors concluded that computer use does not pose a severe occupational hazard for these symptoms (Andersen et al., 2003).

A systematic review of eight studies found that every one of them had limitations, and concluded that there is insufficient evidence that computer work causes carpal tunnel syndrome (Thomsen et al., 2008). The NHS list of risk factors is mostly about other things, such as pregnancy, being overweight, arthritis, diabetes, a previous wrist injury and work that means gripping hard, like using vibrating tools.

There is a plausible mechanism, though. In 14 healthy people, pressure inside the carpal tunnel was about 12 mmHg higher while dragging with a mouse than with the hand resting on it, and in many of them it went above levels known to alter nerve function. The three mice tested made no difference to the pressure (Keir et al., 1999).

What happened when people with the condition tried one

The most direct test measured carpal tunnel pressure in 21 people with the condition while they used a standard mouse, a vertical mouse, a gel mouse pad and a gliding palm support. Pressure rose whenever they used a mouse. The vertical mouse reduced ulnar deviation, the sideways bend of the wrist towards the little finger, and the pads reduced how far the wrist bent back. None of them lowered carpal tunnel pressure, and the authors left the choice to personal preference (Schmid et al., 2015).

A Cochrane review of ergonomic equipment for treating carpal tunnel syndrome found only two trials, with 105 people, and both tested keyboards rather than mice. It concluded that there is not enough evidence to say whether ergonomic positioning or equipment helps or harms (O’Connor et al., 2012).

What do trials in real offices show?

The largest trial we found followed 206 engineers who used a computer for more than 20 hours a week, for a year. They were randomly given a conventional mouse, an alternative mouse, a forearm support board, or the alternative mouse and the board together. Over the year, 42 of them were diagnosed with a new musculoskeletal disorder.

The forearm board reduced discomfort in the right arm. The alternative mouse pointed in a helpful direction, with fewer new right-arm disorders and slightly less neck and shoulder discomfort, but neither difference was statistically significant (Conlon et al., 2008). The abstract does not describe the mouse’s shape, so this is not a test of vertical mice as such.

The same team measured nerve function at the wrist in 154 of the engineers. The alternative mouse appeared to protect the ulnar nerve, which runs along the little-finger side of the wrist, but had no significant effect on the median nerve, the one involved in carpal tunnel syndrome (Conlon et al., 2009).

What reviews of workplace changes found

Two systematic reviews have weighed workplace interventions for the arms and hands. The first, of 36 studies, found moderate evidence for arm supports and strong evidence that adjusting the workstation alone made no difference (Kennedy et al., 2010). The update, drawing on 61 studies, found strong evidence for workplace resistance training, moderate evidence for stretching programmes, feedback on mouse use and forearm supports, and moderate evidence of no benefit from workstation adjustment (Van Eerd et al., 2016). Alternative mice are not among the interventions that either abstract lists as having evidence of benefit.

The trade-off: speed and a learning curve

Expect to be slower at first. In the 16-person study, reaching a target took longer on the vertical mouse, 4.2 seconds against 3.4 on the standard one (Quemelo & Vieira, 2013). In the text-editing study, people were less productive and rated the upright hand position as less comfortable (Gustafsson & Hagberg, 2003).

When 18 women worked through a pointing and clicking task again and again, they reached a steady speed after about 30 repetitions on both a slanted and a vertical mouse. Learning seemed slower on the vertical one, and the authors suggested that decision-makers and employees consider a slanted design instead (Clarisse et al., 2022).

These studies lasted minutes or hours, not weeks. If your work depends on fast, precise pointing, our page for graphic designers looks at mouse-heavy work in more detail.

What matters as much as the mouse

If your wrist, forearm or shoulder aches at the computer, the mouse shape is one factor among several, and the others have at least as much evidence.

• Where the mouse sits. In a study of 30 adults, a mouse placed centrally, between the keyboard and the body, gave the most neutral arm posture, and a mouse on the desk above a keyboard tray gave the least neutral posture and the highest muscle activity (Dennerlein & Johnson, 2006). In 12 adults, centrally placed pointing devices gave more neutral shoulder postures and lower forearm muscle activity than a conventional mouse or a trackball (Lin et al., 2015).
• Support for the forearm. Arm supports have more trial evidence than any mouse shape. In a lab study of 16 people, a forearm support cut the turning load on the shoulder (shoulder flexion torque) by 90%, and people reported less discomfort (Onyebeke et al., 2014). Armrests are part of a good office chair setup, and the desk height calculator suggests a desk and chair height for your body.
• Variety and breaks. The researchers who measured carpal tunnel pressure advised keeping dragging tasks short and often doing something else with the mousing hand. In the UK, employers must carry out a workstation assessment for regular screen users and make sure they take breaks or change activity (HSE). Our workstation checklist covers the same ground, and microbreaks looks at how often to move.
• Strength and movement. Resistance training had the strongest evidence in the 61-study review, and stretching programmes had moderate evidence. A forearm stretch from the app is described on our wrist stretches page, and the wider question is weighed in Stretching or strengthening?

If the ache sits more in the shoulder than the wrist, see shoulder pain from computer work. If you work mostly on a laptop, start with working on a laptop without straining your neck.

Who might want to try a vertical mouse?

If a flat mouse makes your forearm ache, a vertical or slanted mouse is a sensible experiment: the lab evidence on forearm twisting is consistent. Judge it once you are used to it, not on the first afternoon. If you already have numbness or tingling, it may feel more comfortable, but the evidence suggests it will not take the pressure off the nerve. That is a reason to get the symptoms checked.

When to see a doctor

For carpal tunnel syndrome, the NHS suggests wearing a wrist splint at night and cutting down on things that make you bend your wrist often or grip hard. It advises seeing a GP if your symptoms are getting worse or not going away, or if treatment at home is not working. A health professional can usually tell from your symptoms and an examination, and may refer you for a nerve conduction test if they are not sure (NHS).

For pain from repeated movement more generally, often called repetitive strain injury, the NHS advises keeping active, not resting the affected area for more than a few days, and talking to your employer about changing the way you work. See a GP if the symptoms are not going away or are getting worse. In many areas you can also refer yourself to NHS physiotherapy without a GP referral (NHS).

So, is a vertical mouse better?

• For forearm posture, yes. Less twisting and slightly lower muscle activity.
• For carpal tunnel syndrome, not shown. It did not lower carpal tunnel pressure in people with the condition, and there are no trials of mice as a treatment.
• For preventing pain at work, unproven. The one sizeable trial found trends, not clear effects; a forearm support did better.
• At first, it is slower. Expect a learning curve.

The mouse is one part of the day. The other part is how long the hand and arm stay in one position. The forearm stretch on our wrist page comes from Bavelu’s Between Calls session, which takes under five minutes on a chair. Like the rest of Bavelu’s sessions, it is designed and filmed by physiotherapists.