The only way that I can see to do it on my MBP is to first rotate the image/file in Preview using Cmd + L/R, then insert a text box, type out your text and then rotate the image/file back.
That's pretty unclassy. Also Cmd+L/R, as far as I can tell, only works in 90 degree increments. SURELY if you can do it with a trackpad, there has to be some way to do it with the keyboard.
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