Is there really any difference, or is it really just preference. I have some wrist trouble and I want a paddle that will put the least amount of strain on it. What does everyone use?

It's really just preference. Technically, the less offset the better for your wrist, and that is the theory behind bent shaft paddles, but I learned with an old slalom paddle with about a 90 degree offset, and my wrists are fine. Once you are used to it, changing is hard, and you find that the offset gives you more torque, so if you are looking for a new padle, thry and find a low offset b/s paddle, but if not, it won't make a huge difference.

I just recently switched from a 45 to a 30 when I got my H2O paddle. The left side felt just a little bit odd for one session, but that's it.. 45 and 30 are so close to me that I have yet to see or feel any kind of difference (and I'm pretty picky about paddles).

what would probably help you out the most is experimenting (ie. borrowing friends paddles) with different bent shaft designs to see which works best with you. One person will claim that AT is the most \"ergonomicly correct\" while another person will make the same claim for H2O, another for Riot, another for Lendal, Werner, etc. It quite litteraly is different strokes for different folk because all these guys make good product that have subtle differences.

I know I have not given you an definitive answer, but you are the only one who can feel what is comfortable and what is not. The only thing that will highly recommend is that you get a bent shaft paddle (or try a different brand if you already have one)

In this case less is more.

Unless you are concerned about paddle power for long distances and wind resistance on the blade that is out of the water you just don't realy need a lot of twist.
If you are playboating o small if you can. 30 is good but 12 is even better.
If you can add a bent shaft to the equation you should see a great reduction in stress to your wrists.
If you don't mind the couple af additional grams on your paddle you should check out the H2O team paddle.
The grip can be ordered for your grip ssize too which also help to improve comfort.
(For everyone else: let's not reopen the discussion of weight and paddles please).
If you can, try before you buy.\
There is my 2 cents worth.
Cheers

I've found under 15 degree offset to be best for whitewater use in general.

First, if you have small hands, get a paddle with a small shaft. Most of the Werner paddles give you the option of a regular or small shaft. Secondly, I would recommend that you consider a paddle that has an adjustible offset. A little more money, but your wrists are worth it. The offset is a matter of preference. For surf, I use a 45 degree offset. For touring, I use a 75 degree offset which means a lot less wind resistence when paddling into a headwind. If in doubt... rent a paddle with an adjustable offset, and try different offsets to find what feels best for your paddling style. Also... the larger the blade, the more strain on your wrists.