Over at the Zone, there’s been an interesting discussion about elbow issues some people are having. A Zoner by the handle of River, who is a Werner paddle rep, weighed in with a take on how to hold your paddle to minimize elbow issues and maximize your paddling efficiency. I don’t hold my handle like he suggests — usually I’ve got a two-fisted death grip on it — but I’m going to change my ways next time out. River sez:
The Elbow issues are most likely flaring up because you may be overgripping the shaft with your lower hand trying to stop the flutter. This is why a blade with a dihedral will allow you to maintain a loose grip and keep the elbow issues to a minimum. 
The skinny shafts are basically allowing you to grip the paddle better because of the smaller shaft and control the flutter without having to grip as tightly (because you can get your hand and fingers farther around the shaft)and that is why a small shaft will also reduce your elbow issues. A great analogy is trying to do a pull-up on a thick tree branch compared to a broom handle-the broom handle is easier because you don’t have to overgrip it… Either way a loose grip IMO is the most efficient technique that is also the healthiest. Try making the "ok" symbol with your lower hand and paddle holding the shaft with only the thumb and pointer finger around the paddle. Paddling with the loosest grip possible for a session and see how that can extend your reach and reduce elbow, forearm, and forearm fatigue and leave you feeling more stoked about your paddling sessions.
Weasels Wake adds:
River has it dead on with the lower hand grip. And I use my top hand almost exclusively to raise and lower the paddle in and out of the water, by pulling the handle down, to raise the blade, and visa-versa on the versa-visa Thus, the lower hand becomes a pivot point using my thumb and maybe just two fingers, with a very soft grasp.
BTW, I use a Werner carve, and I LOVE it. Light weight, easy pull, slight oval shape on an average size shaft, and it won’t break the bank in getting one. 