does this suit your needs for a large mouse?
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joking aside... i think you are talking about the sega mega mouse right?
i've seen some mice which might fit your needs around...
there are 3 button wide mice with side scroll wheels...
i could also have swore that i saw a mouse made by microsoft or logitech or one of the common brands which looked like below but instead of being vertical was horizontal... right now it eludes me though
i know they made/make trackball mice how you wanted like below but with just 3 buttons.
another option may be to use your thumb on the side of the mouse instead of your ring finger for the extra button. such as below
now.. i do not have RSI but i am a frequent computer user and know that i do have some issues with my hands. i personally use a razer deathadder because it is wide, a good shape and easy to press with 4 buttons + scroll. not sure if it would work for someone with full blown RSI but it works fine for someone just starting to get hand problems.
there are some 45 degree 3 button mice. not quite horizontal, but not vertical either
its not 3 button, but i've seen wide mice with finger support like below before as well