I absolutely LOVE the ability to rotate my image with the Wacom Intuos 4 scroll wheel! Hours of time at the computer make this very appreciated for comfort. Some times it's a lot more comfortable to brush in a particular direction.
When temporarily rotated like this, brushing up and down along the surface of the Wacom moves the cursor the way you would expect, up and down your display, regardless of the image's real orientation (since rotating with the scroll wheel only rotates the image in VRAM). The problem occurs when you attempt to use the arrow keys on the keyboard to nudge an object with the move tool. The direction of movement in this case ignores the visual orientation of the image, and instead behaves as though the image is not visually rotated. so… if I rotate an image with the Wacom scroll wheel 90 degrees clockwise, using the up arrow with the move tool nudges objects to the left on my display rather than the VISUAL up. VERY not logical! :^)