Looks pretty good, position-wise.
As others have mentioned, the wrist angle looks painful. On the trainer, try resting your fists on the extensions vs. canting your wrist to grab them. If this feels better, consider some lasy-S or ski bend extensions.
Try adding some grip to your saddle; it can help take stress off of your shoulders and elbows. This is a common issue with noseless saddles. A couple of strips of cloth medical tape should do the trick for testing. If it works there are more permanent options.
If you want to experiment with a slightly higher (10-20mm) pad position, you can affix a 2nd set of pads on top of the first set with rubber bands. It's a lot easier than using risers or stem spacers, and you can swap back and forth quickly, even mid-ride.
ECMGN Therapy Silicon Valley: Depression, Neurocognitive problems, Dementias (Testing and Evaluation), Trauma and PTSD, Traumatic Brain Injury (TBI)